MEDICARE: AMANI A MATHIS LMSW

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	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	093056	NY

General Provider Information

NPI Number	:	1518455815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANI A MATHIS LMSW

Provider Business Mailing Address
First Line	:	117 GROVELAND ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-1013
Country	:	US
Telephone Number	:	716-465-1005
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 GROVELAND ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14214-1013
Country	:	US
Telephone Number	:	716-465-1005
Fax Number	:

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

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	09/18/2024

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