Provider Demographics
NPI:1073898946
Name:GORMAN, AMY MARGARET (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARGARET
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 DRAKE DRIVE
Mailing Address - Street 2:DRAKE ELEMENTARY SCHOOL
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120
Mailing Address - Country:US
Mailing Address - Phone:716-807-3734
Mailing Address - Fax:716-807-3726
Practice Address - Street 1:380 DRAKE DRIVE
Practice Address - Street 2:DRAKE ELEMENTARY SCHOOL
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120
Practice Address - Country:US
Practice Address - Phone:716-807-3734
Practice Address - Fax:716-807-3726
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY507601041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01377162Medicaid