MEDICARE: AMY SERIN PHD PLLC

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	101YM0800X	Mental Health Counselor	3859	AZ
2	103TB0200X	Cognitive & Behavioral Psychologist	3859	AZ
3	103TC0700X	Clinical Psychologist	3859	AZ
4	103G00000X	Clinical Neuropsychologist	3859	AZ

General Provider Information

NPI Number	:	1497074769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY SERIN PHD PLLC

Provider Business Mailing Address
First Line	:	9784 W YEARLING RD
Second Line	:	B1580
City	:	PEORIA
State	:	AZ
Zip	:	85383-1379
Country	:	US
Telephone Number	:	623-824-5051
Fax Number	:	623-825-6757

Provider Business Practice Location Address
First Line	:	9784 W YEARLING RD
Second Line	:	B1580
City	:	PEORIA
State	:	AZ
Zip	:	85383-1379
Country	:	US
Telephone Number	:	623-824-5051
Fax Number	:	623-825-6757

Authorized Official
Title or Position	:	NEUROPSYCHOLOGIST
Name	:	DR. AMY SERIN
Credential	:	PHD
Telephone Number	:	623-824-5051

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	05/25/2010

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Directions to “AMY SERIN PHD PLLC ” Practice Location

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