Provider Demographics
NPI:1801978176
Name:OJERHOLM, AMY J (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:J
Last Name:OJERHOLM
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 1:1080 WARBURTON AVE
Mailing Address - Street 2:APT 6E
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:917-783-3099
Mailing Address - Fax:
Practice Address - Street 1:420 MADISON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:917-783-3099
Practice Address - Fax:212-366-8144
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014410103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008961Medicare UPIN