Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 1129520 | NJ |
NPI | 1023609195 |
---|---|
Provider Name | Amanda Heller |
First Address | Lakewood, NJ 08701 |
Second Address | Lakewood, NJ 08701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2021 |
Last Update Date | 01/02/2021 |