Provider Demographics
NPI:1225313547
Name:BEMENT, AMIE
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:BEMENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 W LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1711
Mailing Address - Country:US
Mailing Address - Phone:619-272-6485
Mailing Address - Fax:619-272-6485
Practice Address - Street 1:1427 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1711
Practice Address - Country:US
Practice Address - Phone:619-272-6485
Practice Address - Fax:619-272-6485
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MF#65766106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist