Basic Information
| Provider Information | |||||||||
| NPI: | 1932598604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LICHTER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
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| Credential: | SOCIAL WORKER | ||||||||
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| Mailing Information | |||||||||
| Address1: | THERACARE | ||||||||
| Address2: | 2510 WESTCHESTER AVE SUITE 102 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185975558 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | THERACARE | ||||||||
| Address2: | 2510 WESTCHESTER AVE SUITE 102 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185975558 | ||||||||
| FaxNumber: | 7185977277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2015 | ||||||||
| LastUpdateDate: | 02/18/2015 | ||||||||
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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 | 104100000X | R032979-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.