Healthcare Provider Details

I. General information

NPI: 1518514249
Provider Name (Legal Business Name): AMANDA HAIGHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FAMILY PRACTICE DR
KINGSTON NY
12401-6449
US

IV. Provider business mailing address

1 FAMILY PRACTICE DR
KINGSTON NY
12401-6449
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-6400
  • Fax: 845-633-5765
Mailing address:
  • Phone: 845-338-2562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094970-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: