MEDICARE: AMY OLIVIA REDMOND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	P116392	NY

General Provider Information

NPI Number	:	1154058196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY OLIVIA REDMOND

Provider Business Mailing Address
First Line	:	40 MAIN ST
Second Line	:
City	:	CAMDEN
State	:	NY
Zip	:	13316-1302
Country	:	US
Telephone Number	:	315-533-2570
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 MAIN ST
Second Line	:
City	:	CAMDEN
State	:	NY
Zip	:	13316-1302
Country	:	US
Telephone Number	:	315-533-2570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	08/01/2022

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