Provider Demographics
NPI:1538588330
Name:MARGOLIS, AMY (PHD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MARGOLIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JORALEMON ST
Mailing Address - Street 2:# 3 E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4747
Mailing Address - Country:US
Mailing Address - Phone:718-935-0400
Mailing Address - Fax:
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:# 3 E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4747
Practice Address - Country:US
Practice Address - Phone:718-935-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0148361103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty