Provider Demographics
NPI:1205340874
Name:ALLEN, AMANDA (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 1ST ST APT 34E
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-8999
Mailing Address - Country:US
Mailing Address - Phone:732-236-3846
Mailing Address - Fax:
Practice Address - Street 1:110 1ST ST APT 34E
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-8999
Practice Address - Country:US
Practice Address - Phone:732-236-3846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health