MEDICARE: MS. MARILYN AMICO LMHC

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	101YM0800X	Mental Health Counselor	MH10755	FL

General Provider Information

NPI Number	:	1659655959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN AMICO LMHC

Provider Business Mailing Address
First Line	:	1511 53RD AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-2365
Country	:	US
Telephone Number	:	772-633-5356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 53RD AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-2365
Country	:	US
Telephone Number	:	772-633-5356
Fax Number	:

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

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	10/05/2011

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