Provider Demographics
NPI:1295488302
Name:AMICO, AMY M (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:AMICO
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 1:7331 EAGLE VISTA PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-7705
Mailing Address - Country:US
Mailing Address - Phone:317-446-2995
Mailing Address - Fax:
Practice Address - Street 1:7331 EAGLE VISTA PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46259-7705
Practice Address - Country:US
Practice Address - Phone:317-446-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009276A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical