Provider Demographics
NPI:1316266968
Name:WITHROW, AMANDA D (PHD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:D
Last Name:WITHROW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:BIRNBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60699
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-0699
Mailing Address - Country:US
Mailing Address - Phone:408-596-4940
Mailing Address - Fax:408-689-5143
Practice Address - Street 1:230 S CALIFORNIA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1642
Practice Address - Country:US
Practice Address - Phone:408-596-4940
Practice Address - Fax:408-689-5143
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23529103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical