Active NPI
Amy Nicole Hebb, PSY.D.
- Clinical Psychologist
- Bridgeport, WV
National Provider Identifier
1366729295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1038
- Practice address
- 65 Professional Place
Suite 101
Bridgeport, WV 26330 - Phone
- (304) 842-6463
- Fax
- (304) 842-8180
- NPI assigned
- Nov 6, 2011
- 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 | 1038 | WV | Primary |
Addresses
Primary practice location
65 Professional Place
Suite 101
Bridgeport, WV 26330
Mailing address
65 Professional Place
Suite 101
Bridgeport, WV 26330
Phone (304) 842-6463
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810022680 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320537600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397692800000",
"number": "1366729295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 PROFESSIONAL PLACE",
"address_2": "SUITE 101",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "26330",
"telephone_number": "304-842-6463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 PROFESSIONAL PLACE",
"address_2": "SUITE 101",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "26330",
"telephone_number": "304-842-6463",
"fax_number": "304-842-8180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEBB",
"first_name": "AMY",
"middle_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-06",
"last_updated": "2014-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WV",
"license": "1038",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810022680",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.