Provider Demographics
NPI:1659343911
Name:AMADOR, CATHLEEN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:M
Last Name:AMADOR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 E EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4096
Mailing Address - Country:US
Mailing Address - Phone:219-462-4770
Mailing Address - Fax:219-464-8156
Practice Address - Street 1:2102 E EVANS AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4096
Practice Address - Country:US
Practice Address - Phone:219-462-4770
Practice Address - Fax:219-464-8156
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041768A103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200385770AMedicaid
IN200385770AMedicaid