Provider Demographics
NPI:1619644259
Name:WEISBROT, AMANDA JOY
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:WEISBROT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOY
Other - Last Name:MULVIHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:727 N BROADWAY STE B1
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2348
Mailing Address - Country:US
Mailing Address - Phone:800-871-5491
Mailing Address - Fax:
Practice Address - Street 1:1500 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1551
Practice Address - Country:US
Practice Address - Phone:516-739-7733
Practice Address - Fax:516-739-3923
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2025-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY100332011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker