Provider Demographics
NPI:1134522055
Name:LOERINC GUINYARD, AMANDA (PHD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LOERINC GUINYARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:LOERINC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:76 STONLEY RD APT 27
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-5600
Mailing Address - Country:US
Mailing Address - Phone:617-843-3886
Mailing Address - Fax:
Practice Address - Street 1:76 STONLEY RD APT 27
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-5600
Practice Address - Country:US
Practice Address - Phone:617-843-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31258103TC0700X
390200000X
MA11374103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program