Provider Demographics
NPI:1649527953
Name:HERBERT, AMY MARIE (MS SP ED)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JASMINE LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3923
Mailing Address - Country:US
Mailing Address - Phone:631-780-6953
Mailing Address - Fax:
Practice Address - Street 1:15 JASMINE LN
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3923
Practice Address - Country:US
Practice Address - Phone:631-780-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist