Provider Demographics
NPI:1245013614
Name:LOEFFLER, AMANDA M (MS, LAC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:LOEFFLER
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 RUTLEDGE CT N
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-9723
Mailing Address - Country:US
Mailing Address - Phone:732-290-2254
Mailing Address - Fax:
Practice Address - Street 1:179 AVENUE AT THE CMN
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4804
Practice Address - Country:US
Practice Address - Phone:908-415-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00627900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health