Provider Demographics
NPI:1568080125
Name:MEAD, AMANDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:MEAD
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 NASHUA ST STE 19
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3717
Mailing Address - Country:US
Mailing Address - Phone:603-688-6726
Mailing Address - Fax:
Practice Address - Street 1:52 NASHUA ST STE 19
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3717
Practice Address - Country:US
Practice Address - Phone:603-688-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026364103T00000X
103T00000X
NH1490103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8847OtherAUTHORITY TO PRACTICE INTERJURISDICTIONAL TELEPSYCHOLOGY (APIT)