Provider Demographics
NPI:1447840186
Name:OLDAKOWSKI, AMANDA SUE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SUE
Last Name:OLDAKOWSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:NY
Mailing Address - Zip Code:12124-0264
Mailing Address - Country:US
Mailing Address - Phone:518-291-2639
Mailing Address - Fax:
Practice Address - Street 1:905 GREENE COUNTY OFFICE BLDG
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-2868
Practice Address - Country:US
Practice Address - Phone:518-622-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111384-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker