Provider Demographics
NPI:1659018802
Name:WALDRON, AMY R (MA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 S BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5128
Mailing Address - Country:US
Mailing Address - Phone:909-368-4255
Mailing Address - Fax:
Practice Address - Street 1:600 N ARROWHEAD AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1148
Practice Address - Country:US
Practice Address - Phone:909-522-4656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist