Provider Demographics
NPI:1710543509
Name:FIERSTEIN, AMANDA DANIELLE SMITH
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DANIELLE SMITH
Last Name:FIERSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-1115
Mailing Address - Country:US
Mailing Address - Phone:970-925-5858
Mailing Address - Fax:
Practice Address - Street 1:227 MIDLAND AVE STE 15B
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8119
Practice Address - Country:US
Practice Address - Phone:970-925-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health