Provider Demographics
NPI:1023453230
Name:AMATO, JANICE MARIE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARIE
Last Name:AMATO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:JANICE
Other - Middle Name:MARIE
Other - Last Name:AMATO WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:856 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1924
Mailing Address - Country:US
Mailing Address - Phone:917-414-8521
Mailing Address - Fax:516-437-4745
Practice Address - Street 1:303 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6601
Practice Address - Country:US
Practice Address - Phone:212-946-1190
Practice Address - Fax:516-437-4745
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069575-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical