Provider Demographics
NPI:1619287141
Name:WEISSER-BENNETT, AMY NADINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NADINE
Last Name:WEISSER-BENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:NADINE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:600 S BENITA BLVD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2675
Mailing Address - Country:US
Mailing Address - Phone:607-757-2335
Mailing Address - Fax:607-757-2229
Practice Address - Street 1:600 S BENITA BLVD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-757-2335
Practice Address - Fax:607-757-2229
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0787241041C0700X
NY078724-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical