Provider Demographics
NPI:1942503438
Name:BOATMAN, AMANDA D (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:BOATMAN
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAKE PLAZA 2 ROUTE 706 EAST
Mailing Address - Street 2:RR7 BOX 7117
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LAKE PLAZA 2 ROUTE 706 EAST
Practice Address - Street 2:RR7 BOX 7117
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801
Practice Address - Country:US
Practice Address - Phone:570-278-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health