Provider Demographics
NPI:1043408198
Name:WERTHEIMER, AMY VANESSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:VANESSA
Last Name:WERTHEIMER
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 1:2222 BANCROFT WAY
Mailing Address - Street 2:3RD FLOOR, COUNSELING & PSYCHOLOGICAL SERVICES
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4301
Mailing Address - Country:US
Mailing Address - Phone:510-642-9331
Mailing Address - Fax:510-642-2368
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:3RD FLOOR, COUNSELING & PSYCHOLOGICAL SERVICES
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4301
Practice Address - Country:US
Practice Address - Phone:510-642-9331
Practice Address - Fax:510-642-2368
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist