Individual
AMANDA LEE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
624 ELIZABETH ST, UTICA, NY 13501-2413
(315) 732-6228
Mailing address
211 SHORE AVE, SYRACUSE, NY 13209-1123
(315) 956-5147
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
112404
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112404
—
NY
Enumeration date
11/30/2022
Last updated
11/30/2022
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