Healthcare Provider Details

I. General information

NPI: 1629247143
Provider Name (Legal Business Name): AMY EARGLE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8439 MEDITERRANEAN WAY
SACRAMENTO CA
95826-1667
US

IV. Provider business mailing address

2443 FAIR OAKS BLVD # 354
SACRAMENTO CA
95825-7684
US

V. Phone/Fax

Practice location:
  • Phone: 916-216-8824
  • Fax:
Mailing address:
  • Phone: 916-216-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15890
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY15890
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY15890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: