Provider Demographics
NPI:1972669588
Name:ROBERTS, AMANDA KAREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KAREN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 WEST ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2997
Mailing Address - Country:US
Mailing Address - Phone:413-253-0440
Mailing Address - Fax:
Practice Address - Street 1:441 WEST ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2997
Practice Address - Country:US
Practice Address - Phone:413-253-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1859587OtherMASSHEALTH
MA467798OtherTUFTS
MA32638OtherHEALTH NEW ENGLAND
MAW06297OtherBLUE CROSS BLUE SHIELD
MA1895605Medicaid
MAW51140Medicare ID - Type Unspecified
MA1895605Medicaid