Provider Demographics
NPI:1659660462
Name:AMLICK, ANNMARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:ANNMARIE
Middle Name:
Last Name:AMLICK
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 1:6 CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5355
Mailing Address - Country:US
Mailing Address - Phone:516-850-1856
Mailing Address - Fax:
Practice Address - Street 1:13030 180TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4108
Practice Address - Country:US
Practice Address - Phone:718-527-2200
Practice Address - Fax:718-527-3707
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health