| NPI | 1295222644 |
|---|---|
| Former Name | AMANDA TETREAULT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121188) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC20932) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904013872) | |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2022-04-26 |