Healthcare Provider Details

I. General information

NPI: 1497583579
Provider Name (Legal Business Name): AMY MERENDA EDD, LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 D ST
GALT CA
95632-1932
US

IV. Provider business mailing address

519 D ST
GALT CA
95632-1932
US

V. Phone/Fax

Practice location:
  • Phone: 916-572-9947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number4256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: