Provider Demographics
NPI:1992866081
Name:AMYOTTE, THOMAS ALFRED (CRC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALFRED
Last Name:AMYOTTE
Suffix:
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1739
Mailing Address - Country:US
Mailing Address - Phone:518-483-9452
Mailing Address - Fax:
Practice Address - Street 1:209 PARK STREET
Practice Address - Street 2:CITIZEN ADVOCATES INC
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-483-3261
Practice Address - Fax:518-483-3383
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002836-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health