Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | R040238 | NY |
NPI | 1003244476 |
---|---|
Provider Name | Amy Antoniazzi |
First Address | Merrick, NY 11566-2523 |
Second Address | Merrick, NY 11566-2523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2013 |
Last Update Date | 23/10/2013 |