Provider Demographics
NPI:1093440133
Name:AVERY, AMY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:AVERY
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 1:3316 ROSECROFT LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4868
Mailing Address - Country:US
Mailing Address - Phone:630-452-1922
Mailing Address - Fax:
Practice Address - Street 1:113 E VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4947
Practice Address - Country:US
Practice Address - Phone:630-452-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health