Provider Demographics
NPI:1063155638
Name:BERNEY, AMANDA (PSYD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BERNEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 ALTRURIA DR APT 434
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0168
Mailing Address - Country:US
Mailing Address - Phone:724-263-1037
Mailing Address - Fax:
Practice Address - Street 1:970 ALTRURIA DR APT 434
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0168
Practice Address - Country:US
Practice Address - Phone:724-263-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33212103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling