Provider Demographics
NPI:1124708177
Name:KEROLES, AMBER (PSYD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:KEROLES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:HARDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:844-928-1872
Mailing Address - Fax:
Practice Address - Street 1:39650 LIBERTY ST STE 140
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2225
Practice Address - Country:US
Practice Address - Phone:510-498-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical