Provider Demographics
NPI:1548740301
Name:WALDMAN, AMANDA REILLY
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:REILLY
Last Name:WALDMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4257
Mailing Address - Country:US
Mailing Address - Phone:508-361-2091
Mailing Address - Fax:
Practice Address - Street 1:500 VICTORY RD STE 24
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-3109
Practice Address - Country:US
Practice Address - Phone:617-847-1926
Practice Address - Fax:617-774-1490
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAX101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health