Provider Demographics
NPI:1164666574
Name:WALLWORK, AMY (LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WALLWORK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WELSH RD
Mailing Address - Street 2:202
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6310
Mailing Address - Country:US
Mailing Address - Phone:215-914-2119
Mailing Address - Fax:215-914-1663
Practice Address - Street 1:727 WELSH RD
Practice Address - Street 2:202
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6310
Practice Address - Country:US
Practice Address - Phone:215-914-2119
Practice Address - Fax:215-914-1663
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist