Provider Demographics
NPI:1689926354
Name:SOFTIC, AMY L
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:SOFTIC
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 1:83 HOSPITAL RD
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:BALDWINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01436-1215
Mailing Address - Country:US
Mailing Address - Phone:978-652-1136
Mailing Address - Fax:
Practice Address - Street 1:83 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BALDWINVILLE
Practice Address - State:MA
Practice Address - Zip Code:01436-1215
Practice Address - Country:US
Practice Address - Phone:978-652-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor