Healthcare Provider Details

I. General information

NPI: 1073122339
Provider Name (Legal Business Name): AMANDA JOSEPHINE PICCICHE MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SKYWAY DR
CAMARILLO CA
93010-8552
US

IV. Provider business mailing address

1232 CHALMETTE AVE
VENTURA CA
93003-5848
US

V. Phone/Fax

Practice location:
  • Phone: 805-504-1155
  • Fax: 805-383-1134
Mailing address:
  • Phone: 586-719-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: