Provider Demographics
NPI:1255687018
Name:AMATO, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:AMATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 41ST ST
Mailing Address - Street 2:APT 2J
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3260
Mailing Address - Country:US
Mailing Address - Phone:917-647-2684
Mailing Address - Fax:
Practice Address - Street 1:10326 68TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3200
Practice Address - Country:US
Practice Address - Phone:718-261-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0719881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical