Provider Demographics
NPI:1518608652
Name:KOHL, AMY MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:KOHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 1ST ST APT K315
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6638
Mailing Address - Country:US
Mailing Address - Phone:562-522-3117
Mailing Address - Fax:
Practice Address - Street 1:333 1ST ST APT K315
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6638
Practice Address - Country:US
Practice Address - Phone:657-464-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS222121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical