Healthcare Provider Details

I. General information

NPI: 1831663806
Provider Name (Legal Business Name): AMANDA MARIE ABBOTT I LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 WILLIAM ST
LYONS NY
14489-1119
US

IV. Provider business mailing address

3105 PILGRIMPORT RD
LYONS NY
14489-9331
US

V. Phone/Fax

Practice location:
  • Phone: 585-363-0933
  • Fax:
Mailing address:
  • Phone: 315-216-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104744-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098179-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: