Healthcare Provider Details

I. General information

NPI: 1750285540
Provider Name (Legal Business Name): AMY LEIGH LACRETA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 OSWEGO ST
UTICA NY
13502-5031
US

IV. Provider business mailing address

5 OAKWOOD DR
NEW HARTFORD NY
13413-2459
US

V. Phone/Fax

Practice location:
  • Phone: 313-798-8868
  • Fax: 315-733-7105
Mailing address:
  • Phone: 719-439-4719
  • Fax: 315-733-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018534-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: