Provider Demographics
NPI:1427118108
Name:AMBLER, CHERYL KATHRYN (PHD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:KATHRYN
Last Name:AMBLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 STRATFORD PL
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-2145
Mailing Address - Country:US
Mailing Address - Phone:650-941-9250
Mailing Address - Fax:650-941-1867
Practice Address - Street 1:20370 TOWN CENTER LN
Practice Address - Street 2:SUITE 168
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3213
Practice Address - Country:US
Practice Address - Phone:408-517-0764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17000103G00000X
CAPSY#17000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical