Provider Demographics
NPI:1962528646
Name:ANDERSON, AMY (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:ANDERSON
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 1:3900 DARROW RD UNIT 2704
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-7345
Mailing Address - Country:US
Mailing Address - Phone:330-620-8535
Mailing Address - Fax:234-380-5930
Practice Address - Street 1:209 S MAIN ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308
Practice Address - Country:US
Practice Address - Phone:330-620-8535
Practice Address - Fax:234-380-5930
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1982839536OtherNPI ORGANIZATION