Provider Demographics
NPI:1104024090
Name:AMUNDSEN, ADRIENNE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:ELIZABETH
Last Name:AMUNDSEN
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 1:417 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1711
Mailing Address - Country:US
Mailing Address - Phone:415-751-6948
Mailing Address - Fax:
Practice Address - Street 1:417 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1711
Practice Address - Country:US
Practice Address - Phone:415-751-6948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7865103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist