Provider Demographics
NPI:1578028817
Name:RICKS, AMBER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:RICKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 1ST AVE APT 401D
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3533
Mailing Address - Country:US
Mailing Address - Phone:315-746-0573
Mailing Address - Fax:
Practice Address - Street 1:12301 ACADEMY WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2000
Practice Address - Country:US
Practice Address - Phone:301-761-2767
Practice Address - Fax:301-881-8043
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1001362103T00000X
NJ944467103TS0200X
MD05983103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool