=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831663806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA MARIE ABBOTT I LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2019
-----------------------------------------------------
Last Update Date | 02/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6539 ANTHONY DR STE A
-----------------------------------------------------
City | VICTOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14564-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-398-8835
-----------------------------------------------------
Fax | 585-398-7376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 WILLIAM ST
-----------------------------------------------------
City | LYONS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14489-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-216-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 104744-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 098179-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------