MEDICARE: AMY A SANSEVERINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	202539	TX

General Provider Information

NPI Number	:	1003128612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY A SANSEVERINO

Provider Business Mailing Address
First Line	:	2116 THOMPSON RD STE 107
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-5415
Country	:	US
Telephone Number	:	346-440-1394
Fax Number	:	832-471-6544

Provider Business Practice Location Address
First Line	:	2116 THOMPSON RD STE 107
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-5415
Country	:	US
Telephone Number	:	346-440-1394
Fax Number	:	832-471-6544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	10/10/2024

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Directions to “ AMY A SANSEVERINO ” Practice Location

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