Individual
DR. LETICIA C AMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
121 W LEXINGTON DR, SUITE 346, GLENDALE, CA 91203-2203
(818) 480-6517
Mailing address
121 W LEXINGTON DR, SUITE 346, GLENDALE, CA 91203-2203
(818) 480-6517
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
3497
AZ
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY 21549
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GV818Z
MEDICARE PTAN
CA
Enumeration date
01/05/2006
Last updated
04/02/2014
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