Provider Demographics
NPI:1558812347
Name:FAVRETTO, AMANDA (LMHC, LAC, NCC, CCTP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FAVRETTO
Suffix:
Gender:F
Credentials:LMHC, LAC, NCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GARVEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3628
Mailing Address - Country:US
Mailing Address - Phone:973-706-6629
Mailing Address - Fax:
Practice Address - Street 1:11 GARVEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3628
Practice Address - Country:US
Practice Address - Phone:973-706-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00323600101Y00000X
NY006590-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health