Provider Demographics
NPI:1558750588
Name:CORTESE, AMANDA LEIGH (MA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:CORTESE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 CENTRAL AVE
Mailing Address - Street 2:SUITE 2, UNIT D
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820
Mailing Address - Country:US
Mailing Address - Phone:978-225-3412
Mailing Address - Fax:603-434-3101
Practice Address - Street 1:130 CENTRAL AVE
Practice Address - Street 2:SUITE 2, UNIT D
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:978-225-3412
Practice Address - Fax:603-434-3101
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC6401101YM0800X
MA13010-MH-CC101YM0800X
NH1081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3077845Medicaid