Provider Demographics
NPI:1730509423
Name:DEPAUL, AMANDA (EDS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DEPAUL
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4460
Mailing Address - Country:US
Mailing Address - Phone:216-749-8597
Mailing Address - Fax:
Practice Address - Street 1:1905 SPRING RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4460
Practice Address - Country:US
Practice Address - Phone:216-749-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20801133103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool