Provider Demographics
NPI:1427145416
Name:SCHOENENBERGER, AMY J (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:J
Last Name:SCHOENENBERGER
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 1:5480 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1552
Mailing Address - Country:US
Mailing Address - Phone:510-420-1749
Mailing Address - Fax:925-688-2200
Practice Address - Street 1:5480 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1552
Practice Address - Country:US
Practice Address - Phone:510-420-1749
Practice Address - Fax:925-688-2200
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7537103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 7537Medicaid
CA00PL75370Medicare ID - Type UnspecifiedID #
CAQ07548Medicare UPIN