Provider Demographics
NPI:1255712725
Name:AMIE, THERESA R (LMHC)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:R
Last Name:AMIE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 BROWNCROFT BLVD
Mailing Address - Street 2:SUITE L-120
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-1435
Mailing Address - Country:US
Mailing Address - Phone:585-673-2519
Mailing Address - Fax:
Practice Address - Street 1:2480 BROWNCROFT BLVD
Practice Address - Street 2:SUITE L-120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-1435
Practice Address - Country:US
Practice Address - Phone:585-673-2519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health