Provider Demographics
NPI:1992560528
Name:YANG, AMANDA ELIESSE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ELIESSE
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELIESSE
Other - Last Name:ROOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:234 SHAWMUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2927
Mailing Address - Country:US
Mailing Address - Phone:413-404-8480
Mailing Address - Fax:
Practice Address - Street 1:249 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1679
Practice Address - Country:US
Practice Address - Phone:413-540-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician