Individual
MS. AMANDA JOHANNA MENARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1901 CLEVELAND AVE, SANTA ROSA, CA 95401-4282
(707) 576-0818
(707) 576-7845
Mailing address
612 PALOMINO DR, SANTA ROSA, CA 95401-5409
(707) 484-3411
(707) 576-7845
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT36689
CA
Other
Enumeration date
10/22/2012
Last updated
10/22/2012
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