Provider Demographics
NPI:1912769233
Name:DWYER, AMANDA MARGARET
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARGARET
Last Name:DWYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARGARET
Other - Last Name:LOSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7851 S ELATI ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8081
Mailing Address - Country:US
Mailing Address - Phone:303-351-5153
Mailing Address - Fax:
Practice Address - Street 1:7851 S ELATI ST STE 203
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8081
Practice Address - Country:US
Practice Address - Phone:303-351-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001808101YA0400X
COLPC.0020238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)