Healthcare Provider Details

I. General information

NPI: 1205252525
Provider Name (Legal Business Name): AMY DURIE MSSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 W 23RD ST
ERIE PA
16506-5803
US

IV. Provider business mailing address

2153 W 4TH ST
ERIE PA
16505-2280
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-2755
  • Fax:
Mailing address:
  • Phone: 484-433-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023280
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: