Provider Demographics
NPI:1427173665
Name:BACH, AMY K (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:K
Last Name:BACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:BACH
Other - Last Name:DILELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:154 WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3116
Mailing Address - Country:US
Mailing Address - Phone:401-374-6893
Mailing Address - Fax:
Practice Address - Street 1:154 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-374-6893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical