Provider Demographics
NPI:1053797530
Name:BORAAS, AMANDA ROSE HERNANDEZ (LADC LMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE HERNANDEZ
Last Name:BORAAS
Suffix:
Gender:F
Credentials:LADC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 COMMERCE DR STE 272
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4502
Mailing Address - Country:US
Mailing Address - Phone:651-983-3348
Mailing Address - Fax:
Practice Address - Street 1:680 COMMERCE DR STE 272
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4502
Practice Address - Country:US
Practice Address - Phone:651-983-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303413101YA0400X
MN3275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)