Provider Demographics
NPI:1932330891
Name:LORRAIN, AMANDA JOY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JOY
Last Name:LORRAIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:JOY
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4185 ST GEORGE RD
Mailing Address - Street 2:CEDAR BROOK
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7695
Mailing Address - Country:US
Mailing Address - Phone:802-651-7738
Mailing Address - Fax:
Practice Address - Street 1:4185 ST GEORGE RD
Practice Address - Street 2:CEDAR BROOK
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7695
Practice Address - Country:US
Practice Address - Phone:802-651-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0047383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical