Provider Demographics
NPI:1760835920
Name:AMANDA SPERANDIO, LMFT
Entity Type:Organization
Organization Name:AMANDA SPERANDIO, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPERANDIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-927-4339
Mailing Address - Street 1:323 N COLONY ST
Mailing Address - Street 2:APT D
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3164
Mailing Address - Country:US
Mailing Address - Phone:203-927-4339
Mailing Address - Fax:
Practice Address - Street 1:416 HIGHLAND AVE
Practice Address - Street 2:BUILDING B, OFFICE A
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2527
Practice Address - Country:US
Practice Address - Phone:203-927-4339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001762251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health