Provider Demographics
NPI:1427797588
Name:FEDERICO, AMIE (ATR-BC, CBIS, LPC)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:FEDERICO
Suffix:
Gender:F
Credentials:ATR-BC, CBIS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEEMAN ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-6053
Mailing Address - Country:US
Mailing Address - Phone:484-896-8895
Mailing Address - Fax:
Practice Address - Street 1:239 4TH AVE STE 1801
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1716
Practice Address - Country:US
Practice Address - Phone:412-532-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011457101YP2500X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103647570-001Medicaid