Provider Demographics
NPI:1043546567
Name:TEICH, AMY (LCSW-R)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TEICH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 COLLEGE POINT BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2241
Mailing Address - Country:US
Mailing Address - Phone:347-804-8277
Mailing Address - Fax:718-321-0917
Practice Address - Street 1:1814 COLLEGE POINT BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2241
Practice Address - Country:US
Practice Address - Phone:347-804-8277
Practice Address - Fax:718-321-0917
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027231-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical