Provider Demographics
NPI:1164713079
Name:FAIR, AMY M (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:FAIR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WALPOLE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3315
Mailing Address - Country:US
Mailing Address - Phone:781-686-4049
Mailing Address - Fax:
Practice Address - Street 1:1 WALPOLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3315
Practice Address - Country:US
Practice Address - Phone:781-686-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1179021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical