Provider Demographics
NPI:1730256900
Name:JACQUES, AMANDA JEAN (LMHC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:JACQUES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:WEINBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:20 MILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01535-1213
Mailing Address - Country:US
Mailing Address - Phone:508-637-1444
Mailing Address - Fax:
Practice Address - Street 1:30 MARY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1110
Practice Address - Country:US
Practice Address - Phone:413-531-9218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health