Provider Demographics
NPI:1578653929
Name:ARCHER, AMY L (LCSW-R)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:ARCHER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 LAKE AVENUE
Mailing Address - Street 2:EVELYN BRANDON HEALTH CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608
Mailing Address - Country:US
Mailing Address - Phone:585-368-6900
Mailing Address - Fax:585-368-6955
Practice Address - Street 1:81 LAKE AVENUE
Practice Address - Street 2:EVELYN BRANDON HEALTH CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608
Practice Address - Country:US
Practice Address - Phone:585-368-6900
Practice Address - Fax:585-368-6955
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0468711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare ID - Type Unspecified70008A GROUP