Provider Demographics
NPI:1851500250
Name:DEWILDT, AMANDA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:DEWILDT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:HUTCHINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1 MIDDLE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4391
Mailing Address - Country:US
Mailing Address - Phone:603-998-2660
Mailing Address - Fax:
Practice Address - Street 1:1 MIDDLE ST STE 206
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4391
Practice Address - Country:US
Practice Address - Phone:603-998-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH120106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99560059Medicaid