Individual
AMANDA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
10 N MAIN ST, CORTLAND, NY 13045-2130
(607) 753-0234
(607) 753-0286
Mailing address
10 N MAIN ST, CORTLAND, NY 13045-2130
(607) 753-0234
(607) 753-0286
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
085552
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336163963
—
NY
Enumeration date
06/25/2013
Last updated
06/25/2013
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