MEDICARE: JAMES F. SKALICKY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY12446	CA

General Provider Information

NPI Number	:	1134249915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES F. SKALICKY PH.D.

Provider Business Mailing Address
First Line	:	2030 E ROUTE 66
Second Line	:	# 200
City	:	GLENDORA
State	:	CA
Zip	:	91740-4602
Country	:	US
Telephone Number	:	626-963-4384
Fax Number	:	626-963-4954

Provider Business Practice Location Address
First Line	:	2030 E ROUTE 66
Second Line	:	# 200
City	:	GLENDORA
State	:	CA
Zip	:	91740-4602
Country	:	US
Telephone Number	:	626-963-4384
Fax Number	:	626-963-4954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/30/2008

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