Provider Demographics
NPI:1962994228
Name:VERHAAK, AMANDA (MSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VERHAAK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 STRATHMORE RD APT 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7101
Mailing Address - Country:US
Mailing Address - Phone:901-413-8294
Mailing Address - Fax:
Practice Address - Street 1:35 SUMMER ST STE 202
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3469
Practice Address - Country:US
Practice Address - Phone:508-828-1308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker