Provider Demographics
NPI:1912040445
Name:CHEVROLET, AMY HERREMA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:HERREMA
Last Name:CHEVROLET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10340 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95436-9806
Mailing Address - Country:US
Mailing Address - Phone:707-308-9538
Mailing Address - Fax:
Practice Address - Street 1:KEYSTONE THERAPY AND TRAINING SERVICES
Practice Address - Street 2:4415 SONOMA HWY STE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4165
Practice Address - Country:US
Practice Address - Phone:707-308-9538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA204361041C0700X
CALCS204361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical