Provider Demographics
NPI:1710693429
Name:AMAYA, ANNA MARIE (LSW)
Entity Type:Individual
Prefix:
First Name:ANNA MARIE
Middle Name:
Last Name:AMAYA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3146
Mailing Address - Country:US
Mailing Address - Phone:973-932-7321
Mailing Address - Fax:
Practice Address - Street 1:158 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-1967
Practice Address - Country:US
Practice Address - Phone:973-932-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL066546001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical