Provider Demographics
NPI:1932598604
Name:LICHTER, AMY (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LICHTER
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THERACARE
Mailing Address - Street 2:2510 WESTCHESTER AVE SUITE 102
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:718-597-5558
Mailing Address - Fax:
Practice Address - Street 1:THERACARE
Practice Address - Street 2:2510 WESTCHESTER AVE SUITE 102
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-597-5558
Practice Address - Fax:718-597-7277
Is Sole Proprietor?:No
Enumeration Date:2015-01-17
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032979-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker