Provider Demographics
NPI:1609410919
Name:LUMADUE, AMANDA G (LMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:LUMADUE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 SOUTHWESTERN BLVD STE 210A
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1860
Mailing Address - Country:US
Mailing Address - Phone:716-342-7926
Mailing Address - Fax:716-312-1904
Practice Address - Street 1:4535 SOUTHWESTERN BLVD STE 210A
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1860
Practice Address - Country:US
Practice Address - Phone:716-342-7926
Practice Address - Fax:716-312-1904
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY011623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health