Provider Demographics
NPI:1740424282
Name:AMICO, TRICIA (LAC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:AMICO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 BENGEYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EAST WILLISTON
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1401
Mailing Address - Country:US
Mailing Address - Phone:516-746-3983
Mailing Address - Fax:
Practice Address - Street 1:147 BENGEYFIELD DR
Practice Address - Street 2:
Practice Address - City:EAST WILLISTON
Practice Address - State:NY
Practice Address - Zip Code:11596-1401
Practice Address - Country:US
Practice Address - Phone:516-746-3983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0-3199171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist