Provider Demographics
NPI:1023299526
Name:AMICK, DEBORAH LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LOUISE
Last Name:AMICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 SOUTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-3279
Mailing Address - Country:US
Mailing Address - Phone:260-672-0491
Mailing Address - Fax:
Practice Address - Street 1:12333 SOUTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-3279
Practice Address - Country:US
Practice Address - Phone:260-672-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004132A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical