Provider Demographics
NPI:1467672105
Name:MARICLE, AMY JOHNSON (LMHC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JOHNSON
Last Name:MARICLE
Suffix:
Gender:F
Credentials:LMHC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SCHOOL ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2339
Mailing Address - Country:US
Mailing Address - Phone:508-964-2029
Mailing Address - Fax:
Practice Address - Street 1:34 SCHOOL ST
Practice Address - Street 2:SUITE 209
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2339
Practice Address - Country:US
Practice Address - Phone:508-964-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health