Provider Demographics
NPI:1679592448
Name:AMATO, JOSEPH J (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:AMATO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 TOPELIS DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-5616
Mailing Address - Country:US
Mailing Address - Phone:203-554-3420
Mailing Address - Fax:
Practice Address - Street 1:1004 TOPELIS DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-5616
Practice Address - Country:US
Practice Address - Phone:203-554-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001686103T00000X
FLPY7545103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP00253270OtherRAILROAD MEDICARE