Provider Demographics
NPI:1255841912
Name:HOSTETTER, AMY L (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:HOSTETTER
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 1:1521 CONCORD PIKE
Mailing Address - Street 2:STE 204
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3645
Mailing Address - Country:US
Mailing Address - Phone:302-655-2627
Mailing Address - Fax:302-655-2613
Practice Address - Street 1:1521 CONCORD PIKE STE 204
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3645
Practice Address - Country:US
Practice Address - Phone:302-655-2627
Practice Address - Fax:302-655-2613
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128261104100000X
DEQ1-00015731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker