Provider Demographics
NPI:1063681880
Name:QUAYLE, AMANDA BARTON (PSYD,)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BARTON
Last Name:QUAYLE
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 1:3101 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5802
Mailing Address - Country:US
Mailing Address - Phone:619-665-4143
Mailing Address - Fax:
Practice Address - Street 1:3101 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5802
Practice Address - Country:US
Practice Address - Phone:619-665-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16841103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical