Healthcare Provider Details

I. General information

NPI: 1568910776
Provider Name (Legal Business Name): AMY SEWART PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 LAUREL CANYON BLVD APT A
LOS ANGELES CA
90046-2138
US

IV. Provider business mailing address

8033 W SUNSET BLVD # 486
LOS ANGELES CA
90046-2401
US

V. Phone/Fax

Practice location:
  • Phone: 310-645-1024
  • Fax:
Mailing address:
  • Phone: 310-645-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number39442
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: