Healthcare Provider Details

I. General information

NPI: 1184172603
Provider Name (Legal Business Name): AMAR R SAXENA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUCHITA SAXENA PHD

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RIDGE TRACE DR APT 205
RALEIGH NC
27606-4373
US

IV. Provider business mailing address

1201 RIDGE TRACE DR APT 205
RALEIGH NC
27606-4373
US

V. Phone/Fax

Practice location:
  • Phone: 919-665-9791
  • Fax:
Mailing address:
  • Phone: 919-665-9791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5676
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016746
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: