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NPI Code Detail

MEDICARE: AMY WAXMAN

MEDICARE: AMY WAXMAN
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1568591394
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY WAXMAN
Provider Business Mailing Address
First Line : 1516 BEVERLY PL
Second Line :
City : ALBANY
State : CA
Zip : 94706-2508
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3200 ADELINE ST
Second Line :
City : BERKELEY
State : CA
Zip : 94703-2407
Country : US
Telephone Number : 510-601-0203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/09/2008

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Directions to “ AMY WAXMAN ” Practice Location

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