Amanda E Fargo, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

21619 Issued in CA

Practice address

231A Main St
Ben Lomond, CA 95005-9394

Phone

(831) 246-0456

NPI assigned

Aug 23, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557273600000",
    "number": "1336455740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MISSION ST STE 106",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950603687",
            "telephone_number": "831-246-0456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231A MAIN ST",
            "city": "BEN LOMOND",
            "state": "CA",
            "postal_code": "950059394",
            "telephone_number": "831-246-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARGO",
        "first_name": "AMANDA",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-23",
        "last_updated": "2019-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "21619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Weh Daume
• Thomas Brian Demma
• Jadee Bea Dickerson
• Mikhaila Noelle Duncan
• Amy Dunniway, LMFT
• Felicitas V. Ferid, L.AC.
• Kristina Fernandez
• Michael Charles Fitzgerald, RN,CNS
• Richard Flores
• Michele Fournier

• Clinical Psychologist in Ben Lomond, CA
• Providers in Ben Lomond, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.