Provider Demographics
NPI:1134902042
Name:NEAL, AMANDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 ROYCE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6223
Mailing Address - Country:US
Mailing Address - Phone:718-209-6950
Mailing Address - Fax:
Practice Address - Street 1:351 MANVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2166
Practice Address - Country:US
Practice Address - Phone:914-488-4343
Practice Address - Fax:914-639-5688
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021641103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty