Healthcare Provider Details

I. General information

NPI: 1427042605
Provider Name (Legal Business Name): AMY L MINNICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 WYOMING AVE
KINGSTON PA
18704-3721
US

IV. Provider business mailing address

562 WYOMING AVE
KINGSTON PA
18704-3721
US

V. Phone/Fax

Practice location:
  • Phone: 570-552-3720
  • Fax:
Mailing address:
  • Phone: 570-552-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW007440L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: