Provider Demographics
NPI:1407147713
Name:CANTAZARO, AMY ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:CANTAZARO
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 1:1801 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3791
Mailing Address - Country:US
Mailing Address - Phone:612-596-0900
Mailing Address - Fax:612-879-3824
Practice Address - Street 1:1801 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403
Practice Address - Country:US
Practice Address - Phone:612-596-0900
Practice Address - Fax:612-879-3824
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001186103T00000X, 103TC1900X, 103TC2200X
MNLP6272103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent