Healthcare Provider Details

I. General information

NPI: 1932440062
Provider Name (Legal Business Name): AMY MARIE FLORENCE L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date: 05/08/2018
Reactivation Date: 09/11/2026

III. Provider practice location address

1201 S MAIN ST REAR
OLD FORGE PA
18518-2365
US

IV. Provider business mailing address

510 WEDGE DR
DICKSON CITY PA
18519-1586
US

V. Phone/Fax

Practice location:
  • Phone: 570-499-4290
  • Fax: 570-457-4747
Mailing address:
  • Phone: 570-878-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC000150
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: