Provider Demographics
NPI:1700559242
Name:MAROTTA, AMANDA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:MAROTTA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 IRVING ST BSMT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-1312
Mailing Address - Country:US
Mailing Address - Phone:518-705-2404
Mailing Address - Fax:
Practice Address - Street 1:258 HOOSICK ST STE 203
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2450
Practice Address - Country:US
Practice Address - Phone:518-238-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010329-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health