Individual
DR. AMANDA STUDENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, DSW
Contact information
Practice address
2 WOODLAWN RD, LATHAM, NY 12110-4223
(914) 774-6919
Mailing address
2 WOODLAWN RD, LATHAM, NY 12110-4223
(914) 774-6919
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
085834
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245796580
—
NY
Enumeration date
02/12/2019
Last updated
12/04/2020
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