| Doctor Name: | DR. AMANDA LEA GRODEWALD-ADLER |
| NPI Number: | 1144520768 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | P77977 |
| Business Practice Address: | 1919 Middle Country Rd Suite 308 Centereach, NY - 117205601 |
| Business Phone Number: | 6312095343 |
| Business Fax Number: | 6316487655 |
| Mailing Address: | 1919 Middle Country Rd, Suite 308 CENTEREACH |
| State: | NY |
| Postal Code: | 117205601 |
| Phone Number: | 6312095343 |
| Fax Number: | 6316487655 |
| NPI Enumeration Date: | 10/29/2010 |
| NPI Last Update Date: | 10/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | P77977 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |