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General NPI Number Information
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NPI Number | 1790004265
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Entity Type | Individual
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Provider Name | AMIE DAWN PANICACCI MSW, ASW
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Gender | Female
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 15339 SATICOY ST
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City | VAN NUYS
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State | CA
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Zip | 91406-3345
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Country | US
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Telephone | 818-267-2646
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Fax | 818-267-2691
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Provider Business Mailing Address
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Address Line | 1670 AMBERWOOD DR APT C
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-1930
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Country | US
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Telephone | 818-720-7701
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 28045
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License Number State | CA
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