Provider Demographics
NPI:1538673223
Name:HANKO, AMANDA SURACE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:SURACE
Last Name:HANKO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:SURACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:25 CHURCH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3829
Mailing Address - Country:US
Mailing Address - Phone:570-840-9910
Mailing Address - Fax:
Practice Address - Street 1:25 CHURCH ST FL 1
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3829
Practice Address - Country:US
Practice Address - Phone:570-840-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical