Provider Demographics
NPI:1730477175
Name:AMICO, DONALD B
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:AMICO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 WESTCLIFF DR
Mailing Address - Street 2:1084
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-5601
Mailing Address - Country:US
Mailing Address - Phone:702-979-0082
Mailing Address - Fax:
Practice Address - Street 1:5465 REFLEX DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-4606
Practice Address - Country:US
Practice Address - Phone:702-979-0082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health