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General NPI Number Information
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NPI Number | 1063490514
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Entity Type | Individual
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Provider Name | LETICIA C AMICK PHD
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Gender | Female
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 121 W LEXINGTON DR SUITE 346
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City | GLENDALE
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State | CA
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Zip | 91203-2203
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Country | US
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Telephone | 818-480-6517
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Fax |
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Provider Business Mailing Address
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Address Line | 121 W LEXINGTON DR SUITE 346
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City | GLENDALE
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State | CA
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Zip | 91203-2203
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Country | US
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Telephone | 818-480-6517
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 3497
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY 21549
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License Number State | CA
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