Healthcare Provider Details

I. General information

NPI: 1942422951
Provider Name (Legal Business Name): AMANDA GARRETT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORTON AVE
ONEONTA NY
13820-2629
US

IV. Provider business mailing address

1 NORTON AVE
ONEONTA NY
13820-2629
US

V. Phone/Fax

Practice location:
  • Phone: 607-431-5712
  • Fax: 804-355-6031
Mailing address:
  • Phone: 607-431-5712
  • Fax: 804-355-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number074833-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: