Provider Demographics
NPI:1356763528
Name:MCCAULEY, AMY NOELLE (MFT)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:NOELLE
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 VIA EL PRADO STE 204
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5721
Mailing Address - Country:US
Mailing Address - Phone:310-793-6625
Mailing Address - Fax:
Practice Address - Street 1:1711 VIA EL PRADO STE 204
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5721
Practice Address - Country:US
Practice Address - Phone:310-793-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42142101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health