Healthcare Provider Details

I. General information

NPI: 1073357646
Provider Name (Legal Business Name): MARISSA LYNN AMATO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 11TH AVE SW
SIDNEY MT
59270-3608
US

IV. Provider business mailing address

218 11TH AVE SW
SIDNEY MT
59270-3608
US

V. Phone/Fax

Practice location:
  • Phone: 406-781-9909
  • Fax:
Mailing address:
  • Phone: 406-781-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-SWLC-LIC-64596
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: