Provider Demographics
NPI:1477073062
Name:MEHTA, AMRITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMRITA
Middle Name:
Last Name:MEHTA
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 1:3 COMMODORE DR # B261
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1646
Mailing Address - Country:US
Mailing Address - Phone:510-394-2240
Mailing Address - Fax:
Practice Address - Street 1:401 GRAND AVE STE 380
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-5054
Practice Address - Country:US
Practice Address - Phone:510-394-2240
Practice Address - Fax:510-380-2558
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29199103G00000X, 103T00000X, 103TC2200X, 103TC0700X
103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities