Provider Demographics
NPI:1154439545
Name:STROM, AMY LYNNE (MSSA LISW-S, LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNNE
Last Name:STROM
Suffix:
Gender:F
Credentials:MSSA LISW-S, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 COSTA MAYA WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928
Mailing Address - Country:US
Mailing Address - Phone:440-665-9387
Mailing Address - Fax:
Practice Address - Street 1:5272 SUMMERLIN COMMONS WAY STE 602
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2156
Practice Address - Country:US
Practice Address - Phone:239-297-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0007058SUPV1041C0700X
FLSW115111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid