Provider Demographics
NPI:1699518860
Name:RIFF, AMANDA LILLIAN (LPAT-A)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LILLIAN
Last Name:RIFF
Suffix:
Gender:F
Credentials:LPAT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2215
Mailing Address - Country:US
Mailing Address - Phone:502-435-5250
Mailing Address - Fax:
Practice Address - Street 1:927 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2215
Practice Address - Country:US
Practice Address - Phone:502-435-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health