Provider Demographics
NPI:1699229245
Name:ZUCKER, AMANDA (ATR-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ZUCKER
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 GALE ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1862
Mailing Address - Country:US
Mailing Address - Phone:917-626-6147
Mailing Address - Fax:
Practice Address - Street 1:1105 GALE ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1862
Practice Address - Country:US
Practice Address - Phone:917-626-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14-139101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor