Provider Demographics
NPI:1801207790
Name:AMICI BEHAVIORAL HEALTH LCSW PLLC
Entity Type:Organization
Organization Name:AMICI BEHAVIORAL HEALTH LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TRAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:585-329-4743
Mailing Address - Street 1:3542 SAINT PAUL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-2716
Mailing Address - Country:US
Mailing Address - Phone:585-329-4743
Mailing Address - Fax:
Practice Address - Street 1:111 E 14TH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:14903-1303
Practice Address - Country:US
Practice Address - Phone:607-734-9539
Practice Address - Fax:607-734-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR017387-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty