Provider Demographics
NPI:1538382940
Name:HARDWICK, AMY (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:HYAMPOM
Mailing Address - State:CA
Mailing Address - Zip Code:96046-0024
Mailing Address - Country:US
Mailing Address - Phone:949-637-3810
Mailing Address - Fax:949-494-6462
Practice Address - Street 1:22567 HYAMPOM ROAD #6
Practice Address - Street 2:#6
Practice Address - City:HYAMPOM
Practice Address - State:CA
Practice Address - Zip Code:96046-9604
Practice Address - Country:US
Practice Address - Phone:949-637-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical