Individual
AMY LYNNE MENDITTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3253 ROUTE 112 STE 10, MEDFORD, NY 11763-1411
(631) 880-7929
Mailing address
3253 ROUTE 112 STE 10, MEDFORD, NY 11763-1411
(631) 880-7929
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
111159-01
NY
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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