Individual
AMANDA DARLENE GERVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
159 W 1ST ST, OSWEGO, NY 13126-2045
(315) 342-9575
Mailing address
10085 COUNTY ROUTE 95, RODMAN, NY 13682-2116
(315) 727-0180
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1107315171
NY
Other
Enumeration date
01/12/2018
Last updated
01/12/2018
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