Provider Demographics
NPI:1396332466
Name:MAURIER, AMANDA JANE (LICSW, MLADC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:MAURIER
Suffix:
Gender:F
Credentials:LICSW, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX G
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-0167
Mailing Address - Country:US
Mailing Address - Phone:802-728-4466
Mailing Address - Fax:
Practice Address - Street 1:10 MEMBERS WAY STE 201
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5933
Practice Address - Country:US
Practice Address - Phone:603-742-2263
Practice Address - Fax:603-740-7116
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1185101YA0400X
NHEL05492101YA0400X
VT151.0134103101YA0400X
NHEL065751041C0700X
NH25381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)