Provider Demographics
NPI:1053543876
Name:LANNIE, AMANDA L (PHD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:LANNIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2786
Mailing Address - Country:US
Mailing Address - Phone:610-542-3178
Mailing Address - Fax:610-542-3087
Practice Address - Street 1:2012 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2786
Practice Address - Country:US
Practice Address - Phone:610-542-3178
Practice Address - Fax:610-542-3087
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-08-4175103K00000X
PAPS016390103TB0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral