Healthcare Provider Details

I. General information

NPI: 1861102782
Provider Name (Legal Business Name): AMANDA WILHELM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PARK LN
HIGHLAND NY
12528-2823
US

IV. Provider business mailing address

29 N HAMILTON ST
POUGHKEEPSIE NY
12601-2541
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-2703
  • Fax:
Mailing address:
  • Phone: 845-486-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number115990
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: