Provider Demographics
NPI:1104328376
Name:ORR, AMY J (LMSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:J
Last Name:ORR
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 1:979 COUNTY ROUTE 25
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5723
Mailing Address - Country:US
Mailing Address - Phone:315-529-1533
Mailing Address - Fax:
Practice Address - Street 1:317 W 1ST ST STE 112
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3678
Practice Address - Country:US
Practice Address - Phone:315-216-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069171104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker