Provider Demographics
NPI:1386824662
Name:WEIR, AMY L (MS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WEIR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:18 AMPERSAND DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6500
Mailing Address - Country:US
Mailing Address - Phone:518-565-4060
Mailing Address - Fax:518-566-0168
Practice Address - Street 1:18 AMPERSAND DR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6500
Practice Address - Country:US
Practice Address - Phone:518-565-4060
Practice Address - Fax:518-566-0168
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health