Provider Demographics
NPI:1316521883
Name:DUANE, AMY KLEIN (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KLEIN
Last Name:DUANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:VANESSA
Other - Last Name:GLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2383 S POLARIS WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2086
Mailing Address - Country:US
Mailing Address - Phone:858-922-0107
Mailing Address - Fax:
Practice Address - Street 1:2383 S POLARIS WAY
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2086
Practice Address - Country:US
Practice Address - Phone:858-922-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA273425101YM0800X
CA25932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health