Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | PSY14696 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY0327 | NV |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY14696 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY0327 | NV |
N | 103G00000X | Clinical Psychologist | PSY14696 | CA |
N | 103TC0700X | Clinical Psychologist | PSY14696 | CA |
Y | 103G00000X | Clinical Psychologist | PY0327 | NV |
Y | 103TC0700X | Clinical Psychologist | PY0327 | NV |
N | 103TF0200X | Forensic Psychologist | PSY14696 | CA |
N | 103TF0200X | Forensic Psychologist | PY0327 | NV |
N | 103TR0400X | Rehabilitation Psychologist | PSY14696 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PY0327 | NV |
NPI | 1013182559 |
---|---|
Provider Name | Dr. Alfredo M Amezaga JR. |
First Address | Reno, NV 89511-8134 |
Second Address | Reno, NV 89511-8134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2008 |
Last Update Date | 17/07/2012 |