Provider Demographics
NPI:1285000802
Name:COLON, AMANDA BETHANIE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETHANIE
Last Name:COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1504
Mailing Address - Country:US
Mailing Address - Phone:860-502-5949
Mailing Address - Fax:
Practice Address - Street 1:74 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2367
Practice Address - Country:US
Practice Address - Phone:860-793-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker