Provider Demographics
NPI:1972875359
Name:DULLIGAN, AMY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:DULLIGAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5902
Mailing Address - Country:US
Mailing Address - Phone:516-797-0068
Mailing Address - Fax:
Practice Address - Street 1:13 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5902
Practice Address - Country:US
Practice Address - Phone:516-797-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050802104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker