Provider Demographics
NPI:1447735592
Name:GARBER, AMY JEANNE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEANNE
Last Name:GARBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 VILLAGE GATE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2432
Mailing Address - Country:US
Mailing Address - Phone:617-312-9244
Mailing Address - Fax:
Practice Address - Street 1:375 TOTTEN POND RD STE 100
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-2026
Practice Address - Country:US
Practice Address - Phone:781-419-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1151681041C0700X
MA11551681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical