Provider Demographics
NPI:1790042414
Name:DEPIPPO, AMANDA GRAY (LMHC, CAP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRAY
Last Name:DEPIPPO
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17886 N US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4502
Mailing Address - Country:US
Mailing Address - Phone:850-519-7578
Mailing Address - Fax:
Practice Address - Street 1:17886 N US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4502
Practice Address - Country:US
Practice Address - Phone:850-519-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9857101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health