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General NPI Number Information
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NPI Number | 1154602878
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Entity Type | Organization
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Legal Business Name | AMY FODOR, LCSW, INC
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 699 17TH ST SUITE D
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City | VERO BEACH
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State | FL
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Zip | 32960-6251
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Country | US
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Telephone | 772-766-2069
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Fax | 772-918-8468
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Provider Business Mailing Address
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Address Line | 801 GRANDIN AVE
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City | SEBASTIAN
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State | FL
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Zip | 32958-5125
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Country | US
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Telephone | 772-766-2069
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Fax | 772-918-8468
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. AMY ELIZABETH FODOR
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Credential | LCSW
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Telephone | 772-766-2069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW3798
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License Number State | FL
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