Provider Demographics
NPI:1629858964
Name:BUNNELL, AMANDA RACHELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RACHELLE
Last Name:BUNNELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 KIRBY RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9262
Mailing Address - Country:US
Mailing Address - Phone:518-587-4277
Mailing Address - Fax:518-583-1196
Practice Address - Street 1:57 KIRBY RD
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9262
Practice Address - Country:US
Practice Address - Phone:518-587-4277
Practice Address - Fax:518-583-1196
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114317-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health