Provider Demographics
NPI:1053351163
Name:REXROTH, AMY LOUISE (PSYD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:REXROTH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1804
Mailing Address - Country:US
Mailing Address - Phone:317-810-1005
Mailing Address - Fax:
Practice Address - Street 1:230 1ST ST NE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1804
Practice Address - Country:US
Practice Address - Phone:317-810-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041891A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000325362OtherBCBS