Doctor Name: | AMY ROSE VERBONICH |
NPI Number: | 1245559574 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | |
Business Practice Address: | 12625 La Mirada Blvd La Mirada, CA - 906382211 |
Business Phone Number: | 5629034800 |
Business Fax Number: | |
Mailing Address: | 12625 La Mirada Blvd, LA MIRADA |
State: | CA |
Postal Code: | 906382211 |
Phone Number: | 5629034800 |
Fax Number: | |
NPI Enumeration Date: | 05/26/2010 |
NPI Last Update Date: | 03/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |