Provider Demographics
NPI:1588790968
Name:WALDMAN, AMY LEE (MSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LEE
Last Name:WALDMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CENTER ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3031
Mailing Address - Country:US
Mailing Address - Phone:413-584-8400
Mailing Address - Fax:
Practice Address - Street 1:16 CENTER ST
Practice Address - Street 2:SUITE 509
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3031
Practice Address - Country:US
Practice Address - Phone:413-584-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10269481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWAPO7400OtherBLUE CROSS NUMBER