Provider Demographics
NPI:1861975039
Name:BAMFORTH, AMY S (MS (ED), MSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:BAMFORTH
Suffix:
Gender:F
Credentials:MS (ED), MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 HARVEY ST,
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1721
Mailing Address - Country:US
Mailing Address - Phone:617-547-0720
Mailing Address - Fax:
Practice Address - Street 1:126 HARVEY ST,
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1721
Practice Address - Country:US
Practice Address - Phone:617-547-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1153541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical