Provider Demographics
NPI:1134249915
Name:SKALICKY, JAMES F (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:SKALICKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 E ROUTE 66
Mailing Address - Street 2:# 200
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4602
Mailing Address - Country:US
Mailing Address - Phone:626-963-4384
Mailing Address - Fax:626-963-4954
Practice Address - Street 1:2030 E ROUTE 66
Practice Address - Street 2:# 200
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4602
Practice Address - Country:US
Practice Address - Phone:626-963-4384
Practice Address - Fax:626-963-4954
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP12446Medicare ID - Type Unspecified