Healthcare Provider Details

I. General information

NPI: 1285510982
Provider Name (Legal Business Name): AMY GENCARELLI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 32ND ST
PHOENIX AZ
85008-6205
US

IV. Provider business mailing address

400 N 32ND ST
PHOENIX AZ
85008-6205
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-222-2752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-006054
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: