Provider Demographics
NPI:1245559574
Name:VERBONICH, AMY ROSE (PSYD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ROSE
Last Name:VERBONICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 LA MIRADA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2211
Mailing Address - Country:US
Mailing Address - Phone:562-903-4800
Mailing Address - Fax:
Practice Address - Street 1:12625 LA MIRADA BLVD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2211
Practice Address - Country:US
Practice Address - Phone:562-903-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional