Provider Demographics
NPI:1750632311
Name:HERTRICK, AMY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HERTRICK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 BECHTEL ST
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-1610
Mailing Address - Country:US
Mailing Address - Phone:724-417-0349
Mailing Address - Fax:
Practice Address - Street 1:1039 BECHTEL ST
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-1610
Practice Address - Country:US
Practice Address - Phone:724-417-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional