Provider Demographics
NPI:1508125493
Name:SUMMERS, AMY (HIGH SCHOOL DIPLOMA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:HIGH SCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596
Mailing Address - Country:US
Mailing Address - Phone:925-286-6050
Mailing Address - Fax:925-937-6782
Practice Address - Street 1:1620 NORTH MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-286-6050
Practice Address - Fax:925-937-6782
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst