Basic Information
| Provider Information | |||||||||
| NPI: | 1396071833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1236 CREEDMOOR AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152262344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125193239 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1011 BINGHAM ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152031101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122355033 | ||||||||
| FaxNumber: | 4122355387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2009 | ||||||||
| LastUpdateDate: | 10/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.