Amanda Waller, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37PC00637200 Issued in NJ

Practice address

154 Waypoint Dr
Eatontown, NJ 07724-2184

Phone

(908) 310-7788

NPI assigned

Aug 25, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1598313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1710590146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 SOUTH STREET PO BOX 1111",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077244111",
            "telephone_number": "908-310-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 WAYPOINT DR",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242184",
            "telephone_number": "908-310-7788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "AMANDA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-25",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00637200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://changingtidescounseling.clientsecure.me",
            "affiliation": "N",
            "address_1": "154 Waypoint Dr",
            "city": "Eatontown",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "077242184",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Monica Wacewicz, LPC
• Mary Wagenhoffer, APRN
• Rosette Sarina Wahba
• Ilan Waldman, M.D.
• Kulbir Walia, MD
• Dana Marie Walsh, OT
• Shane C Walter
• Michael Wappel
• Alexandra Linn Warren
• Mariam Gamal Wassef, D.O.

• Professional Counselor in Eatontown, NJ
• Providers in Eatontown, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; 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.