| Organization Name: | AMANDA NICELY |
| NPI Number: | 1104209204 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMANDA NICELY MACHADO (CEO/PRESIDENT) |
| Mailing Address: | 205 W Grove St Suite E Middleboro |
| State: | MA US |
| Postal Code: | 023461462 |
| Phone Number: | 5089231900 |
| Fax Number: | 5089231991 |
| NPI Enumeration Date: | 07/07/2015 |
| NPI Last Update Date: | 07/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 8644 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |