Provider Demographics
NPI:1992335616
Name:BEGIN, AMANDA (MA, LADC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BEGIN
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:TREHERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LADC
Mailing Address - Street 1:148 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2622
Mailing Address - Country:US
Mailing Address - Phone:860-912-0064
Mailing Address - Fax:
Practice Address - Street 1:270 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1909
Practice Address - Country:US
Practice Address - Phone:866-887-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001360101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)