Provider Demographics
NPI:1861959264
Name:LISS, AMY CH (LMSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:CH
Last Name:LISS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:CH
Other - Last Name:LISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:141 WILLIS CT
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1448
Mailing Address - Country:US
Mailing Address - Phone:516-526-3191
Mailing Address - Fax:
Practice Address - Street 1:6729 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7063
Practice Address - Country:US
Practice Address - Phone:718-456-7001
Practice Address - Fax:718-456-9470
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1227529011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical