Provider Demographics
NPI:1184172603
Name:SAXENA, AMAR R (PHD)
Entity type:Individual
Prefix:DR
First Name:AMAR
Middle Name:R
Last Name:SAXENA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUCHITA
Other - Middle Name:
Other - Last Name:SAXENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1201 RIDGE TRACE DR APT 205
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4373
Mailing Address - Country:US
Mailing Address - Phone:919-665-9791
Mailing Address - Fax:
Practice Address - Street 1:1201 RIDGE TRACE DR APT 205
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-4373
Practice Address - Country:US
Practice Address - Phone:919-665-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5676103T00000X
MI6301016746103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical