Provider Demographics
NPI:1487270856
Name:ABBOTT, AMANDA KATHERINE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHERINE
Last Name:ABBOTT
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 1:49 DREXMORE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1214
Mailing Address - Country:US
Mailing Address - Phone:585-944-8910
Mailing Address - Fax:
Practice Address - Street 1:1160M PITTSFORD VICTOR RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3818
Practice Address - Country:US
Practice Address - Phone:585-944-8910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst