=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154516409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA N. KENDRICK PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2007
-----------------------------------------------------
Last Update Date | 09/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 595 E COLORADO BLVD STE 324
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-839-1365
-----------------------------------------------------
Fax | 626-385-4871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 595 E COLORADO BLVD STE 324
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-839-1365
-----------------------------------------------------
Fax | 626-385-4871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY 23770
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------