Provider Demographics
NPI:1508389289
Name:STOREY, AMY C (MA, MFA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:STOREY
Suffix:
Gender:F
Credentials:MA, MFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COMMERCE ST # 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3761
Mailing Address - Country:US
Mailing Address - Phone:646-573-5290
Mailing Address - Fax:
Practice Address - Street 1:275 NORTH ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1140
Practice Address - Country:US
Practice Address - Phone:914-925-5211
Practice Address - Fax:914-925-5166
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP04399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health