Provider Demographics
NPI:1760679302
Name:STROM, AMY JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JEAN
Last Name:STROM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WILMOT TER
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4123
Mailing Address - Country:US
Mailing Address - Phone:845-452-2372
Mailing Address - Fax:845-452-8563
Practice Address - Street 1:15 WILMOT TER
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-4123
Practice Address - Country:US
Practice Address - Phone:845-452-2372
Practice Address - Fax:845-452-8563
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0732321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical