Provider Demographics
NPI:1093907180
Name:KAMINSKI, AMY L (PHD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:KAMINSKI
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 1:7747 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 255
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2117
Mailing Address - Country:US
Mailing Address - Phone:623-476-7436
Mailing Address - Fax:
Practice Address - Street 1:7747 W DEER VALLEY RD
Practice Address - Street 2:SUITE 255
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2117
Practice Address - Country:US
Practice Address - Phone:623-476-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical