Provider Demographics
NPI:1679301527
Name:AMATO, AMELIA KATHRYN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:KATHRYN
Last Name:AMATO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GRANDFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6906
Mailing Address - Country:US
Mailing Address - Phone:781-366-1985
Mailing Address - Fax:
Practice Address - Street 1:125 ADAMS ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1116
Practice Address - Country:US
Practice Address - Phone:617-916-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2340763363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health