Provider Demographics
NPI:1356730154
Name:FREY, AMANDA J
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:FREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3943
Mailing Address - Country:US
Mailing Address - Phone:732-470-1009
Mailing Address - Fax:
Practice Address - Street 1:142 OAK TREE AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-4407
Practice Address - Country:US
Practice Address - Phone:908-329-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054960001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical