Provider Demographics
NPI:1285255398
Name:MACDONALD, AMANDA ADDOLORATO (PSYD)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ADDOLORATO
Last Name:MACDONALD
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 1:12 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2009
Mailing Address - Country:US
Mailing Address - Phone:917-907-0766
Mailing Address - Fax:
Practice Address - Street 1:12 2ND ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2009
Practice Address - Country:US
Practice Address - Phone:917-907-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ356I00618600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical