Healthcare Provider Details

I. General information

NPI: 1659701860
Provider Name (Legal Business Name): AMY OCHENDUSZKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY HUTCHINSON LCSW

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

1104 COURTLAND CT
FAIRFIELD CA
94534-7444
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax:
Mailing address:
  • Phone: 808-652-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number96874
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: