Amanda Katherine Van Emburgh, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3620 Issued in NC

Practice address

725 Highland Ave
Winston Salem, NC 27101-4206

Phone

(336) 607-8523

NPI assigned

Aug 23, 2006

Sex

Female

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2023 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Family & Child Therapy LLC

  • Clinical Psychologist
  • Vienna, VA
  • NPI 1417552993
  NPD (past) Authorized official

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222905600000",
    "number": "1831205400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 OLD GASTON PL",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033878",
            "telephone_number": "703-864-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 HIGHLAND AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271014206",
            "telephone_number": "336-607-8523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN EMBURGH",
        "first_name": "AMANDA",
        "middle_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2008-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "3620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana Lilia Valenzo
• Valera Counseling Services
• Merida Amarilis Valera, LPCA
• Valerie Benton Center
• Rebecca S. Valla, M.D.
• Alana Eriksen Van Schaick
• Keith Bergen Van Zandt, MD
• Laura M Vance, PHARMD
• Edward Roy Vanderbilt, MSN, APRN, FNP-C
• Patty Susan Vandergrift, RN, NNP-BC

• Clinical Psychologist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.