Provider Demographics
NPI:1508161118
Name:MCNAMARA, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MCNAMARA
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 1:1801 S CATALINA AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5506
Mailing Address - Country:US
Mailing Address - Phone:310-462-4784
Mailing Address - Fax:
Practice Address - Street 1:19401 S VERMONT AVE STE A200
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-4418
Practice Address - Country:US
Practice Address - Phone:310-323-6887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC54009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist