Provider Demographics
NPI:1154743789
Name:PICKERING, AMY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PICKERING
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:ARCHIBALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:985 SHERREN ST W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4408
Mailing Address - Country:US
Mailing Address - Phone:651-755-8218
Mailing Address - Fax:
Practice Address - Street 1:4027 COUNTY ROAD 25
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-2629
Practice Address - Country:US
Practice Address - Phone:612-925-6033
Practice Address - Fax:612-925-8496
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN167591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical