Healthcare Provider Details

I. General information

NPI: 1619909108
Provider Name (Legal Business Name): MELISSA M AMICK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEMORIAL HOSPITAL OF RHODE ISLAND 111 BREWSTER STREET
PAWTUCKET RI
02860
US

IV. Provider business mailing address

MEMORIAL HOSPITAL OF RHODE ISLAND 111 BREWSTER STREET
PAWTUCKET RI
02860
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2326
  • Fax: 401-729-2243
Mailing address:
  • Phone: 401-729-3163
  • Fax: 401-729-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS00863
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS00863
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: