=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942178934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUCENT: PERINATAL AND INFANT PSYCHOLOGICAL SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2025
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1225 ALPINE RD STE 204G
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94596-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-236-0832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1225 ALPINE RD STE 204G
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94596-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-236-0832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | DR. AMANDA MEDRANO
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 925-236-0832
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------