Provider Demographics
NPI:1629709365
Name:SEPULVEDA, AMANDA INEZ
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:INEZ
Last Name:SEPULVEDA
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 1:397 ANGELO DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1627
Mailing Address - Country:US
Mailing Address - Phone:845-857-3280
Mailing Address - Fax:
Practice Address - Street 1:590 6TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2022
Practice Address - Country:US
Practice Address - Phone:917-485-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical