Healthcare Provider Details

I. General information

NPI: 1023315561
Provider Name (Legal Business Name): ASHLEY NICOLE AMOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY WARREN

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MAIN ST
EAST WORCESTER NY
12064-2021
US

IV. Provider business mailing address

37 MAIN ST
EAST WORCESTER NY
12064-2021
US

V. Phone/Fax

Practice location:
  • Phone: 607-435-6326
  • Fax:
Mailing address:
  • Phone: 607-435-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081023-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number078865
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: