Provider Demographics
NPI:1447405634
Name:AMICK, ELLEN-JOAN (LMHC)
Entity Type:Individual
Prefix:
First Name:ELLEN-JOAN
Middle Name:
Last Name:AMICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 BULLARD ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2203
Mailing Address - Country:US
Mailing Address - Phone:508-829-7291
Mailing Address - Fax:
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1464
Practice Address - Country:US
Practice Address - Phone:508-366-0406
Practice Address - Fax:508-366-6221
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0525OtherBCBSMA