Basic Information
| Provider Information | |||||||||
| NPI: | 1578653929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARCHER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 LAKE AVENUE | ||||||||
| Address2: | EVELYN BRANDON HEALTH CENTER | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853686900 | ||||||||
| FaxNumber: | 5853686955 | ||||||||
| Practice Location | |||||||||
| Address1: | 81 LAKE AVENUE | ||||||||
| Address2: | EVELYN BRANDON HEALTH CENTER | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853686900 | ||||||||
| FaxNumber: | 5853686955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 046871 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.