Provider Demographics
NPI:1992234587
Name:NEGRI, AMY M (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:NEGRI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:T
Other - Last Name:MCCUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1227 MAIN ST
Mailing Address - Street 2:STE 302
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2227
Mailing Address - Country:US
Mailing Address - Phone:516-247-9951
Mailing Address - Fax:
Practice Address - Street 1:1227 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2227
Practice Address - Country:US
Practice Address - Phone:516-247-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical