Provider Demographics
NPI:1649551342
Name:WILTON, AMANDA (LMSW, CHC, CLC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WILTON
Suffix:
Gender:F
Credentials:LMSW, CHC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:SPRING BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:14140-0005
Mailing Address - Country:US
Mailing Address - Phone:716-281-3838
Mailing Address - Fax:
Practice Address - Street 1:4184 SENECA ST STE 211
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3051
Practice Address - Country:US
Practice Address - Phone:716-281-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087357104100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program