Amanda Burnside, MA, ATR-BC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC011094 Issued in PA

Practice address

518 Easton Tpke
Lake Ariel, PA 18436-4797

Phone

(570) 689-2644

NPI assigned

Mar 6, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Little Creek Lodge

  • Substance Abuse Rehabilitation Facility
  • Lake Ariel, PA
  • NPI 1508290636
  NPD (past)
• Little Creek Outpatient Services LLC

  • Clinic/Center
  • Lake Ariel, PA
  • NPI 1548716145
  NPD (past)
• Tiffany Griffiths Psy D & Associates Inc

  • Clinical Psychologist
  • Dunmore, PA
  • NPI 1649507831

  Professional

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1154889384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 942",
            "city": "HAMLIN",
            "state": "PA",
            "postal_code": "184270942",
            "telephone_number": "570-689-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 EASTON TPKE",
            "city": "LAKE ARIEL",
            "state": "PA",
            "postal_code": "184364797",
            "telephone_number": "570-689-2644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNSIDE",
        "first_name": "AMANDA",
        "credential": "MA, ATR-BC, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC011094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcela Blair, LCSW
• Jessica Rae Bodzio, MS,RDN,LDN
• Derek Jay Bowers, M.D.
• Sabrina Brennan
• Joseph John Brogenski Jr., RPH
• Bridgette Denise Cannella, RD, LDN
• Heather Chapman, RPH
• Richard Chowanec, OTA/L
• Lee McDonald Defazio, CRNP
• Devereux Foundation

• Professional Counselor in Lake Ariel, PA
• Providers in Lake Ariel, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.