Provider Demographics
NPI:1518734938
Name:ROZELL, AMANDA BROOKS
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOKS
Last Name:ROZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51711 ANNIE AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7978
Mailing Address - Country:US
Mailing Address - Phone:845-200-9580
Mailing Address - Fax:
Practice Address - Street 1:34 LINDEN ST APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3796
Practice Address - Country:US
Practice Address - Phone:646-801-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health