Provider Demographics
NPI:1861186116
Name:TAYLOR, AMANDA PAIGE (NCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PAIGE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1241
Mailing Address - Country:US
Mailing Address - Phone:570-905-5629
Mailing Address - Fax:
Practice Address - Street 1:201 LACKAWANNA AVE STE 316
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1953
Practice Address - Country:US
Practice Address - Phone:570-766-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health