Basic Information
| Provider Information | |||||||||
| NPI: | 1538627633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONKLIN | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LCSW, LADC I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 995 WORTHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011094027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132335352 | ||||||||
| FaxNumber: | 4137377949 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 WILBRAHAM AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011093337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137475384 | ||||||||
| FaxNumber: | 4133827170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2019 | ||||||||
| LastUpdateDate: | 03/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 224642 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.