Active NPI
Amy Malloy Takesian, PSY.D.
- Clinical Psychologist
- Royersford, PA
National Provider Identifier
1891856449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 8789
- Practice address
- 1516 Brooke Dr
Royersford, PA 19468-1872 - Phone
- (617) 285-2316
- NPI assigned
- Dec 13, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS019407 | PA | |
| Clinical Psychologist | 103TC0700X | 8789 | MA | Primary |
Addresses
Primary practice location
1516 Brooke Dr
Royersford, PA 19468-1872
Mailing address
1516 Brooke Dr
Royersford, PA 19468-1872
Phone (617) 285-2316
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8789 | MA | MD | Clinical Psychologist |
| PS019407 | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677456000000",
"number": "1891856449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1516 BROOKE DR",
"city": "ROYERSFORD",
"state": "PA",
"postal_code": "194681872",
"telephone_number": "617-285-2316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1516 BROOKE DR",
"city": "ROYERSFORD",
"state": "PA",
"postal_code": "194681872",
"telephone_number": "617-285-2316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAKESIAN",
"first_name": "AMY",
"middle_name": "MALLOY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-13",
"last_updated": "2023-02-27",
"certification_date": "2023-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS019407",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "8789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royersford, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.