Provider Demographics
NPI:1679362081
Name:MISTRETTA, AMANDA NICOLE (MA, NCC, LAC, CADC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:MISTRETTA
Suffix:
Gender:
Credentials:MA, NCC, LAC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2964
Mailing Address - Country:US
Mailing Address - Phone:609-285-3527
Mailing Address - Fax:
Practice Address - Street 1:152 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2964
Practice Address - Country:US
Practice Address - Phone:609-285-3527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00801600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist