Healthcare Provider Details

I. General information

NPI: 1558060970
Provider Name (Legal Business Name): AMANDA GRACE RACHETTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA SABINS LMSW

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 JAMES ST
SYRACUSE NY
13203-2730
US

IV. Provider business mailing address

212 MYRON RD
SYRACUSE NY
13219-1226
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-4471
  • Fax:
Mailing address:
  • Phone: 607-329-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: