Provider Demographics
NPI:1518603109
Name:PETTINELLI, AMANDA (LMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PETTINELLI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KATELYNS WAY
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-1436
Mailing Address - Country:US
Mailing Address - Phone:484-247-4774
Mailing Address - Fax:
Practice Address - Street 1:3553 W CHESTER PIKE STE 130
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3701
Practice Address - Country:US
Practice Address - Phone:484-247-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty