Provider Demographics
NPI:1629601737
Name:EPNER, AMY BETH KUSEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:BETH KUSEL
Last Name:EPNER
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 1:8148 GILMAN CT
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2933
Mailing Address - Country:US
Mailing Address - Phone:858-622-9165
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE C121
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1707
Practice Address - Country:US
Practice Address - Phone:858-768-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist