Provider Demographics
NPI:1760963680
Name:BACHMAN, AMANDA LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LISA
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 UPPER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3654
Mailing Address - Country:US
Mailing Address - Phone:203-942-5197
Mailing Address - Fax:
Practice Address - Street 1:52 FEDERAL RD STE 2A
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6162
Practice Address - Country:US
Practice Address - Phone:203-942-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CT123161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker