Provider Demographics
NPI:1194074260
Name:VAUGHAN, AMANDA (LMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VAUGHAN
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 1:30 FRANKLIN ST
Mailing Address - Street 2:UNIT 106
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6508
Mailing Address - Country:US
Mailing Address - Phone:603-261-6045
Mailing Address - Fax:
Practice Address - Street 1:3 DUNDEE PARK DR STE 203
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-475-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health