Provider Demographics
NPI:1255819652
Name:QUILTY, AMY (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:QUILTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 W ATLANTIC BLVD # 773272
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7462
Mailing Address - Country:US
Mailing Address - Phone:954-406-8429
Mailing Address - Fax:
Practice Address - Street 1:8801 W ATLANTIC BLVD # 773272
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7462
Practice Address - Country:US
Practice Address - Phone:954-406-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW154521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW15452OtherLCSW