Provider Demographics
NPI:1588127682
Name:KLIMASZEWSKI, AMANDA M (BS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:KLIMASZEWSKI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:304 MINEAH RD
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-9622
Mailing Address - Country:US
Mailing Address - Phone:607-279-7841
Mailing Address - Fax:
Practice Address - Street 1:380 FREEVILLE RD
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-9684
Practice Address - Country:US
Practice Address - Phone:607-844-6492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)