MEDICARE: DR. AMY ELIZABETH JENKS PSY.D.

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	103TB0200X	Cognitive & Behavioral Psychologist	PSY24451	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY24451	CA
3	103TC0700X	Clinical Psychologist	PSY24451	CA

General Provider Information

NPI Number	:	1740442938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY ELIZABETH JENKS PSY.D.

Provider Business Mailing Address
First Line	:	37 AVENIDA DE ORINDA
Second Line	:
City	:	ORINDA
State	:	CA
Zip	:	94563-2305
Country	:	US
Telephone Number	:	510-363-6337
Fax Number	:	510-992-4037

Provider Business Practice Location Address
First Line	:	37 AVENIDA DE ORINDA
Second Line	:
City	:	ORINDA
State	:	CA
Zip	:	94563-2305
Country	:	US
Telephone Number	:	510-363-6337
Fax Number	:	510-992-4037

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

Provider Enumeration Date	:	06/28/2008
Last Update Date	:	09/23/2015

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