Provider Demographics
NPI:1790451995
Name:AMACHI, CHIKWERE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHIKWERE
Middle Name:
Last Name:AMACHI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-2008
Mailing Address - Country:US
Mailing Address - Phone:919-412-7769
Mailing Address - Fax:
Practice Address - Street 1:418 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-2008
Practice Address - Country:US
Practice Address - Phone:919-412-7769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9318249103TS0200X
PAPS017706103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool