Provider Demographics
NPI:1124424395
Name:BUONFIGLIO, AMANDA (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BUONFIGLIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6761 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-8907
Mailing Address - Country:US
Mailing Address - Phone:518-929-7178
Mailing Address - Fax:
Practice Address - Street 1:73 COUNTY ROUTE 11A
Practice Address - Street 2:
Practice Address - City:CRARYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12521-5510
Practice Address - Country:US
Practice Address - Phone:518-325-2800
Practice Address - Fax:518-325-2820
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090187-1104100000X
NY086365-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker