Healthcare Provider Details

I. General information

NPI: 1154516409
Provider Name (Legal Business Name): AMANDA N. KENDRICK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 324
PASADENA CA
91101-2021
US

IV. Provider business mailing address

595 E COLORADO BLVD STE 324
PASADENA CA
91101-2021
US

V. Phone/Fax

Practice location:
  • Phone: 818-839-1365
  • Fax: 626-385-4871
Mailing address:
  • Phone: 818-839-1365
  • Fax: 626-385-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 23770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: