Provider Demographics
NPI:1750733366
Name:MCINTOSH, AMY LOIS (LMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOIS
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LOIS
Other - Last Name:LA RAIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 SIMPSON LN
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1407
Mailing Address - Country:US
Mailing Address - Phone:508-801-4713
Mailing Address - Fax:
Practice Address - Street 1:4 HARTWELL ST STE 202
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3019
Practice Address - Country:US
Practice Address - Phone:800-852-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10000148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health