Basic Information
| Provider Information | |||||||||
| NPI: | 1629208970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RILLA | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMHC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | RILLA | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | LMHC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 193 LOCUST ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135848700 | ||||||||
| FaxNumber: | 4135172226 | ||||||||
| Practice Location | |||||||||
| Address1: | 193 LOCUST ST STE 2 | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1345848700 | ||||||||
| FaxNumber: | 1345841714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 09/03/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1559 | MA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 10559 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.