Provider Demographics
NPI:1699015321
Name:CARLIN, AMANDA BLAIR (PHD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BLAIR
Last Name:CARLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 BEAUVOIR AVE
Mailing Address - Street 2:EATING DISORDERS PROGRAM, MACII-SUITE 200
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3533
Mailing Address - Country:US
Mailing Address - Phone:908-598-6620
Mailing Address - Fax:908-522-5779
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:EATING DISORDERS PROGRAM, MACII-SUITE 200
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3533
Practice Address - Country:US
Practice Address - Phone:908-598-6620
Practice Address - Fax:908-522-5779
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00503800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical