Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY-297 | ID |
N | 103TC0700X | Clinical Psychologist | PSY-297 | ID |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PSY297 | ID |
N | 103G00000X | Clinical Psychologist | PSY-297 | ID |
N | 103TC0700X | Clinical Psychologist | PSY-297 | ID |
NPI | 1164551537 |
---|---|
Provider Name | Dr. Amy Jo Amarello |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83712-6267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2007 |
Last Update Date | 09/05/2012 |