Provider Demographics
NPI:1295099273
Name:EMERY, AMY (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:EMERY
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MAIN ST STE 241
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3623
Mailing Address - Country:US
Mailing Address - Phone:203-340-4653
Mailing Address - Fax:203-208-3549
Practice Address - Street 1:222 MAIN ST STE 241
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-3623
Practice Address - Country:US
Practice Address - Phone:203-340-4653
Practice Address - Fax:203-208-3549
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0078921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA122987OtherBOARD OF REGISTRATION OF SOCIAL WORKERS
CT007892OtherSTATE OF CT DEPT OF PUBLIC HEALTH