Provider Demographics
NPI:1851383640
Name:AMSDEN, JANE E (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:AMSDEN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:E
Other - Last Name:FABRIKANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2541
Mailing Address - Country:US
Mailing Address - Phone:845-452-1110
Mailing Address - Fax:845-452-1119
Practice Address - Street 1:6529 SPRING BROOK AVE
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3709
Practice Address - Country:US
Practice Address - Phone:845-876-2006
Practice Address - Fax:845-876-2873
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039963-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR039963-1OtherSW LICENSE
N51671Medicare ID - Type Unspecified