Provider Demographics
NPI:1770476053
Name:OLIVEIRA, AMY (PSYD, NSCP, LSSP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:PSYD, NSCP, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3430
Mailing Address - Country:US
Mailing Address - Phone:732-554-4208
Mailing Address - Fax:
Practice Address - Street 1:27 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3430
Practice Address - Country:US
Practice Address - Phone:732-554-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230122711103TS0200X
NJ01250731103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool