Provider Demographics
NPI:1689022600
Name:TOUSSON, AMANDA (CMHC-LP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TOUSSON
Suffix:
Gender:F
Credentials:CMHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 KEATING PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6146
Mailing Address - Country:US
Mailing Address - Phone:917-518-1038
Mailing Address - Fax:
Practice Address - Street 1:201 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2763
Practice Address - Country:US
Practice Address - Phone:718-815-3155
Practice Address - Fax:718-815-3151
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health