Healthcare Provider Details

I. General information

NPI: 1487465779
Provider Name (Legal Business Name): AMANDA J WILSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMANDA J LOGAN

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HARWOOD CT
SCARSDALE NY
10583-4121
US

IV. Provider business mailing address

14 HARWOOD CT STE 415
SCARSDALE NY
10583-4120
US

V. Phone/Fax

Practice location:
  • Phone: 914-214-9215
  • Fax:
Mailing address:
  • Phone: 914-214-9215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37633
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113012
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099200
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: