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General NPI Number Information
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NPI Number | 1851319487
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Entity Type | Individual
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Provider Name | AMY M. WISNOWSKI LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 462 GRIDER ST
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City | BUFFALO
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State | NY
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Zip | 14215-3021
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Country | US
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Telephone | 716-898-4324
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 DICKENS RD
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City | BLASDELL
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State | NY
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Zip | 14219-2220
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Country | US
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Telephone | 716-984-9615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 066624
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 078635-1
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License Number State | NY
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