Healthcare Provider Details

I. General information

NPI: 1578028817
Provider Name (Legal Business Name): AMBER RICKS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 ACADEMY WAY
ROCKVILLE MD
20852-2000
US

IV. Provider business mailing address

8715 1ST AVE APT 401D
SILVER SPRING MD
20910-3533
US

V. Phone/Fax

Practice location:
  • Phone: 301-761-2767
  • Fax: 301-881-8043
Mailing address:
  • Phone: 315-746-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1001362
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number944467
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05983
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: