Provider Demographics
NPI:1427291921
Name:BALETE, AMY (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:BALETE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:LODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:15525 POMERADO RD STE B1
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2425
Mailing Address - Country:US
Mailing Address - Phone:951-283-0315
Mailing Address - Fax:
Practice Address - Street 1:15525 POMERADO RD STE B1
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2425
Practice Address - Country:US
Practice Address - Phone:951-283-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24979103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist