Provider Demographics
NPI:1740459429
Name:SERIN, AMY (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:SERIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 W HAPPY VALLEY RD
Mailing Address - Street 2:SUITE A135
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2878
Mailing Address - Country:US
Mailing Address - Phone:623-824-5051
Mailing Address - Fax:623-889-9000
Practice Address - Street 1:10200 W HAPPY VALLEY RD
Practice Address - Street 2:SUITE A135
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2878
Practice Address - Country:US
Practice Address - Phone:623-824-5051
Practice Address - Fax:623-889-9000
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3859103G00000X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical