Provider Demographics
NPI:1245671502
Name:ALLEN, AMANDA K (PHD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:K
Last Name:ALLEN
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 1:67 THOMPSON ST
Mailing Address - Street 2:APT. 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4370
Mailing Address - Country:US
Mailing Address - Phone:646-389-3446
Mailing Address - Fax:
Practice Address - Street 1:817 BROADWAY
Practice Address - Street 2:FLOOR 9 RM 14
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4709
Practice Address - Country:US
Practice Address - Phone:646-389-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019662103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical