Healthcare Provider Details

I. General information

NPI: 1497074769
Provider Name (Legal Business Name): AMY SERIN PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9784 W YEARLING RD B1580
PEORIA AZ
85383-1379
US

IV. Provider business mailing address

9784 W YEARLING RD B1580
PEORIA AZ
85383-1379
US

V. Phone/Fax

Practice location:
  • Phone: 623-824-5051
  • Fax: 623-825-6757
Mailing address:
  • Phone: 623-824-5051
  • Fax: 623-825-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3859
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3859
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3859
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3859
License Number StateAZ

VIII. Authorized Official

Name: DR. AMY SERIN
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 623-824-5051