Provider Demographics
NPI:1942596507
Name:ROMANIELLO, AMANDA D (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:ROMANIELLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SHERMAN CT
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5852
Mailing Address - Country:US
Mailing Address - Phone:203-998-5721
Mailing Address - Fax:
Practice Address - Street 1:39 SHERMAN CT
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5852
Practice Address - Country:US
Practice Address - Phone:203-998-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional