Provider Demographics
NPI:1962084632
Name:HAYENGA, AMYNTA OLIVIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMYNTA
Middle Name:OLIVIA
Last Name:HAYENGA
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 1:3500 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2112
Mailing Address - Country:US
Mailing Address - Phone:408-807-7566
Mailing Address - Fax:
Practice Address - Street 1:3500 65TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2112
Practice Address - Country:US
Practice Address - Phone:408-807-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32122103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical