MEDICARE: JEAN DE AMICIS

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	1041C0700X	Clinical Social Worker	I.0010269	OH

General Provider Information

NPI Number	:	1669255980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN DE AMICIS

Provider Business Mailing Address
First Line	:	13204 EXMOOR TERRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5448
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13204 EXMOOR TERRACE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-5448
Country	:	US
Telephone Number	:	281-658-1167
Fax Number	:

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

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	08/18/2023

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Directions to “ JEAN DE AMICIS ” Practice Location

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