Provider Demographics
NPI:1922690684
Name:CHOMANCZUK, AMINDA A (PHD LCSW)
Entity Type:Individual
Prefix:
First Name:AMINDA
Middle Name:A
Last Name:CHOMANCZUK
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:DR
Other - First Name:AMINDA
Other - Middle Name:
Other - Last Name:HECKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LCSW
Mailing Address - Street 1:3 SICKLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2854
Mailing Address - Country:US
Mailing Address - Phone:718-300-6021
Mailing Address - Fax:
Practice Address - Street 1:3 SICKLETOWN RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2854
Practice Address - Country:US
Practice Address - Phone:718-300-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059645001041C0700X
NY0756831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical