Provider Demographics
NPI:1952510448
Name:WAPNER, AMY BETH (MS, ADTR, NYS CAT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:BETH
Last Name:WAPNER
Suffix:
Gender:F
Credentials:MS, ADTR, NYS CAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3533
Mailing Address - Country:US
Mailing Address - Phone:631-423-6518
Mailing Address - Fax:631-423-6518
Practice Address - Street 1:56 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3533
Practice Address - Country:US
Practice Address - Phone:631-423-6518
Practice Address - Fax:631-423-6518
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000368-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1984-ADTR-144OtherACADEMY DMT REGISTERED
NY000368-1OtherCAT LICENSE