Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | 37PC00717300 | NJ |
NPI | 1003433657 |
---|---|
Provider Name | Amanda L. Kent |
First Address | Mountainside, NJ 07092-2221 |
Second Address | Union, NJ 07083-9305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2020 |
Last Update Date | 30/06/2020 |