Provider Demographics
NPI:1376426585
Name:PETERMAN, AMY H (PHD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 MCTAGGART LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5210
Mailing Address - Country:US
Mailing Address - Phone:704-728-6530
Mailing Address - Fax:
Practice Address - Street 1:5743 MCTAGGART LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-5210
Practice Address - Country:US
Practice Address - Phone:704-728-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3231103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service