Healthcare Provider Details

I. General information

NPI: 1235944976
Provider Name (Legal Business Name): AMAE HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 S SAN ANTONIO RD
LOS ALTOS CA
94022-3046
US

IV. Provider business mailing address

3061 FILLMORE ST
SAN FRANCISCO CA
94123-4009
US

V. Phone/Fax

Practice location:
  • Phone: 310-601-5099
  • Fax: 888-988-1786
Mailing address:
  • Phone: 310-601-5099
  • Fax: 888-988-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STAS SOKOLIN
Title or Position: CFO
Credential:
Phone: 347-407-0343