Provider Demographics
NPI:1912361270
Name:KAMMERER, TRUDY (AMFT)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:KAMMERER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17701 SAN PASQUAL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-5301
Mailing Address - Country:US
Mailing Address - Phone:760-233-6003
Mailing Address - Fax:
Practice Address - Street 1:17701 SAN PASQUAL VALLEY RD
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-5301
Practice Address - Country:US
Practice Address - Phone:760-233-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 79865106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist