Provider Demographics
NPI:1891283412
Name:WILLINSKY, AMY MICHELE (LICSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELE
Last Name:WILLINSKY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELE
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:10 SHAWNLEE RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2033
Mailing Address - Country:US
Mailing Address - Phone:781-821-2286
Mailing Address - Fax:
Practice Address - Street 1:1430 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1623
Practice Address - Country:US
Practice Address - Phone:781-647-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical