Provider Demographics
NPI:1861612053
Name:LITTLE, AMEATRISS (MED)
Entity type:Individual
Prefix:MS
First Name:AMEATRISS
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BOSSI AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2002
Mailing Address - Country:US
Mailing Address - Phone:781-986-1078
Mailing Address - Fax:
Practice Address - Street 1:55 TOPEKA STREET
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-442-1499
Practice Address - Fax:617-442-1660
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)