Provider Demographics
NPI:1609933050
Name:REDDING, AMRITA
Entity Type:Individual
Prefix:MRS
First Name:AMRITA
Middle Name:
Last Name:REDDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JOAN
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2422 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1043
Mailing Address - Country:US
Mailing Address - Phone:909-630-3375
Mailing Address - Fax:909-931-2441
Practice Address - Street 1:10630 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6805
Practice Address - Country:US
Practice Address - Phone:909-630-3375
Practice Address - Fax:909-931-2441
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7071103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE423AMedicare PIN
CACP7071Medicare ID - Type Unspecified