Provider Demographics
NPI:1669166732
Name:MCNERNEY, AMANDA LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEE
Last Name:MCNERNEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93011-1387
Mailing Address - Country:US
Mailing Address - Phone:805-233-2550
Mailing Address - Fax:
Practice Address - Street 1:816 CALLE LA RODA
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2731
Practice Address - Country:US
Practice Address - Phone:805-233-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22972103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling