Provider Demographics
NPI:1366442527
Name:FICK, JOEL EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:EDWARD
Last Name:FICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-0188
Mailing Address - Country:US
Mailing Address - Phone:415-528-9111
Mailing Address - Fax:
Practice Address - Street 1:42145 LYNDIE LN
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3612
Practice Address - Country:US
Practice Address - Phone:951-699-4906
Practice Address - Fax:951-587-2625
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022908103TC0700X
CAPSY17903103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022908OtherSTATE LICENSE