Individual
AMANDA J. HACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
465 N MAIN ST, JOHN D. KELLY BEHAVORIAL HEALTH, PENN YAN, NY 14527-1069
(315) 531-2400
Mailing address
233 STILLWATER DR, HORSEHEADS, NY 14845-1330
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
079092
NY
Other
Enumeration date
02/02/2012
Last updated
05/14/2012
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