Active NPI
Amy L Kaminski, PH.D
- Clinical Psychologist
- Peoria, AZ
National Provider Identifier
1093907180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4064
- Practice address
- 7747 W Deer Valley Rd
Suite 255
Peoria, AZ 85382-2117 - Phone
- (623) 476-7436
- NPI assigned
- Aug 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4064 | AZ | Primary |
Addresses
Primary practice location
7747 W Deer Valley Rd
Suite 255
Peoria, AZ 85382-2117
Mailing address
7747 W Deer Valley Rd
Suite 255
Peoria, AZ 85382-2117
Phone (623) 476-7436
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 15, 2020 through Jun 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4064 | AZ | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Child and Family Therapy Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Child & Adolescent Psychologist
- Peoria, AZ
- NPI 1164341004
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255651200000",
"number": "1093907180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7747 W DEER VALLEY RD",
"address_2": "SUITE 255",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853822117",
"telephone_number": "623-476-7436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7747 W DEER VALLEY RD",
"address_2": "SUITE 255",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853822117",
"telephone_number": "623-476-7436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAMINSKI",
"first_name": "AMY",
"middle_name": "L",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-13",
"last_updated": "2009-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "4064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.