MEDICARE: AMANDA WILTON LMSW, CHC, CLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	087357	NY

General Provider Information

NPI Number	:	1649551342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA WILTON LMSW, CHC, CLC

Provider Business Mailing Address
First Line	:	PO BOX 22
Second Line	:
City	:	SPRING BROOK
State	:	NY
Zip	:	14140-0022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 22
Second Line	:
City	:	SPRING BROOK
State	:	NY
Zip	:	14140-0022
Country	:	US
Telephone Number	:	716-281-3838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2011
Last Update Date	:	11/24/2025

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