Provider Demographics
NPI:1508134115
Name:BLANCHARD, AMY (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:BLANCHARD
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 1:20045 STEVENS CREEK BLVD
Mailing Address - Street 2:SUITE D-2B
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2353
Mailing Address - Country:US
Mailing Address - Phone:650-823-1157
Mailing Address - Fax:
Practice Address - Street 1:20045 STEVENS CREEK BLVD
Practice Address - Street 2:SUITE D-2B
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2353
Practice Address - Country:US
Practice Address - Phone:650-823-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9701103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4102980OtherAETNA
CA2813510OtherCIGNA
CA76612OtherMANAGED HEALTH NETWORK