Provider Demographics
NPI:1700622636
Name:HERTZ, AMY R
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:HERTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2868 E PLAIMOR AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6909
Mailing Address - Country:US
Mailing Address - Phone:760-333-8084
Mailing Address - Fax:
Practice Address - Street 1:4525 E CAMINO PAROCELA
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1531
Practice Address - Country:US
Practice Address - Phone:760-333-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP2632103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool