Provider Demographics
NPI:1851824122
Name:LOWELL, AMANDA FAITH (MS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FAITH
Last Name:LOWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1124
Mailing Address - Country:US
Mailing Address - Phone:203-785-2548
Mailing Address - Fax:
Practice Address - Street 1:230 S FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1124
Practice Address - Country:US
Practice Address - Phone:203-785-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical