MEDICARE: MRS. AMY STARLITE HUDDLE LCSW

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	1041C0700X	Clinical Social Worker	0904007796	VA
2	1041C0700X	Clinical Social Worker	LCSW128344	CA

General Provider Information

NPI Number	:	1164780821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY STARLITE HUDDLE LCSW

Provider Business Mailing Address
First Line	:	19270 HIGHWAY 12
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-5414
Country	:	US
Telephone Number	:	707-939-6070
Fax Number	:	707-939-6077

Provider Business Practice Location Address
First Line	:	19270 HIGHWAY 12
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-5414
Country	:	US
Telephone Number	:	707-939-6070
Fax Number	:	707-939-6077

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

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	05/19/2026

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