Provider Demographics
NPI:1386761906
Name:AMDURSKY, AUDREY SHEILAH (LCSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:SHEILAH
Last Name:AMDURSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:AMDURSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:123 E 64TH ST
Mailing Address - Street 2:A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7059
Mailing Address - Country:US
Mailing Address - Phone:212-737-5151
Mailing Address - Fax:212-486-7133
Practice Address - Street 1:123 E 64TH ST
Practice Address - Street 2:A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7059
Practice Address - Country:US
Practice Address - Phone:212-737-5151
Practice Address - Fax:212-486-7133
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0275401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical