Provider Demographics
NPI:1114271228
Name:MARKOWITZ, AMIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:
Last Name:MARKOWITZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:AMIE
Other - Middle Name:SHAPIRO
Other - Last Name:MARKOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:57 HURTIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3816
Mailing Address - Country:US
Mailing Address - Phone:631-509-2643
Mailing Address - Fax:631-331-0138
Practice Address - Street 1:755 WAVERLY AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1190
Practice Address - Country:US
Practice Address - Phone:631-509-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076218-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker