Basic Information
| Provider Information | |||||||||
| NPI: | 1730552829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRYAN | ||||||||
| FirstName: | AMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1418 COTTAGE ST | ||||||||
| Address2: | APT. #3 | ||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945016936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142604758 | ||||||||
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| Practice Location | |||||||||
| Address1: | 957 INDUSTRIAL RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940704151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508326900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2015 | ||||||||
| LastUpdateDate: | 11/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT89386 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.