Provider Demographics
NPI:1083035836
Name:JAMES, AMANDA SOMMERS (PHD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SOMMERS
Last Name:JAMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1440
Mailing Address - Country:US
Mailing Address - Phone:585-703-7147
Mailing Address - Fax:585-486-3034
Practice Address - Street 1:90 E MAIN ST APT 3
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1440
Practice Address - Country:US
Practice Address - Phone:585-703-7147
Practice Address - Fax:585-486-3034
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020718103TC2200X, 103T00000X
NYP89739390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program