Healthcare Provider Details

I. General information

NPI: 1366442527
Provider Name (Legal Business Name): JOEL EDWARD FICK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42145 LYNDIE LN SUITE 102
TEMECULA CA
92591-3612
US

IV. Provider business mailing address

PO BOX 188
LIVERMORE CA
94551-0188
US

V. Phone/Fax

Practice location:
  • Phone: 951-699-4906
  • Fax: 951-587-2625
Mailing address:
  • Phone: 415-528-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number022908
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: