Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 006879 | CT |
NPI | 1003010836 |
---|---|
Provider Name | Amanda M Cuevas |
First Address | Suffield, CT 06078-1423 |
Second Address | Suffield, CT 06078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 15/05/2018 |