Provider Demographics
NPI:1154510329
Name:ZACHARY, AMY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:ZACHARY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 NEWTOWN LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-2494
Mailing Address - Country:US
Mailing Address - Phone:917-327-6237
Mailing Address - Fax:
Practice Address - Street 1:62 NEWTOWN LN
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2494
Practice Address - Country:US
Practice Address - Phone:917-327-6237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0326001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical