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DR. AMANDA E FARGO PSY.D.

Clinical >> Psychologist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1336455740

Individual Registrant:
DR. AMANDA E FARGO PSY.D.
Gender: F
Sole Proprietor

Location and contact information for practice:
231A MAIN ST  BEN LOMOND, CA 95005-9394 US
Tel: 831-246-0456  Fax: --

Contact information for business:
501 MISSION ST STE 106  SANTA CRUZ, CA 95060-3687 US
Tel: 831-246-0456  Fax: --

Registration Information:
NPI: 1336455740
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103TC0700XBehavioral Health & Social Service Providers
Psychologist
Clinical
CA21619

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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