Provider Demographics
NPI:1952636300
Name:BORDFELD FERGUSON, AMANDA (PSYD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BORDFELD FERGUSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E DARRAH LN
Mailing Address - Street 2:NONE
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3763
Mailing Address - Country:US
Mailing Address - Phone:609-403-6190
Mailing Address - Fax:
Practice Address - Street 1:31 E DARRAH LN
Practice Address - Street 2:NONE
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3763
Practice Address - Country:US
Practice Address - Phone:609-403-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health