Healthcare Provider Details

I. General information

NPI: 1306192570
Provider Name (Legal Business Name): AMANDA R. W. STEINER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SAN DIEGO AVE. (664BU)
SAN DIEGO CA
92110-2928
US

IV. Provider business mailing address

2121 SAN DIEGO AVE. (664BU)
SAN DIEGO CA
92110-2928
US

V. Phone/Fax

Practice location:
  • Phone: 619-497-8467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number25143
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number25143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: