Provider Demographics
NPI:1770863094
Name:SZYMCZAK, AMANDA CHENOA (LPCMH)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:CHENOA
Last Name:SZYMCZAK
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MONT BLANC BLVD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7615
Mailing Address - Country:US
Mailing Address - Phone:302-531-6267
Mailing Address - Fax:
Practice Address - Street 1:103 MONT BLANC BLVD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7615
Practice Address - Country:US
Practice Address - Phone:302-678-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
DEPC-0000641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor