=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518216373
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY GAMRAT LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2012
-----------------------------------------------------
Last Update Date | 09/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 144 COVERT AVE
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-326-5560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1536 4TH ST
-----------------------------------------------------
City | WEST BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11704-4756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-298-6299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | 061667-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------