Amanda Koennicke, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

097.0133085 Issued in VT

Practice address

53 Cross Road
Derby, VT 05829

Phone

(802) 487-7801

NPI assigned

Oct 31, 2025

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1761868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761868800000",
    "number": "1982573606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 CROSS RD",
            "city": "NEWPORT",
            "state": "VT",
            "postal_code": "058558856",
            "telephone_number": "802-487-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 CROSS ROAD",
            "city": "DERBY",
            "state": "VT",
            "postal_code": "05829",
            "telephone_number": "802-487-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENNICKE",
        "first_name": "AMANDA",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-31",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "VT",
            "license": "097.0133085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas J Halligan Jr.
• Emily Lyn Jankowski, M.S., LCMHC
• Jessica R Judd
• Michael Thomas Kentoski, PHARM.D.
• Kingdom Therapeutics at Safe Haven Farm, Incorporated
• Myra Barbara Ladaga Castillo, RPH
• Dennis E Leblanc, DDS
• Karen Elizabeth Leroy, EDD, MSN, CPNP, PMHS
• Nancy C Loomis, LICSW
• Anne C Lynch, LICSW

• Mental Health Counselor in Derby, VT
• Providers in Derby, VT by specialty
• Mental Health Counselor in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; 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.