Provider Demographics
NPI:1407693971
Name:MAREK-MISKOLCZI, AMANDA (LADC-II)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MAREK-MISKOLCZI
Suffix:
Gender:F
Credentials:LADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:LAKE PLEASANT
Mailing Address - State:MA
Mailing Address - Zip Code:01347-0043
Mailing Address - Country:US
Mailing Address - Phone:413-588-6113
Mailing Address - Fax:
Practice Address - Street 1:51 LOCUST ST STE 1
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2060
Practice Address - Country:US
Practice Address - Phone:413-584-7425
Practice Address - Fax:413-584-7440
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23650101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)