Provider Demographics
NPI:1861633729
Name:MACKINNON, AMANDA O'NEIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:O'NEIL
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 PARK MANOR BLVD # 140
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-4805
Mailing Address - Country:US
Mailing Address - Phone:805-878-1595
Mailing Address - Fax:805-878-1595
Practice Address - Street 1:1525 PARK MANOR BLVD # 140
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4805
Practice Address - Country:US
Practice Address - Phone:805-878-1595
Practice Address - Fax:805-878-1595
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22582103TC0700X
PAPS017015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical