Basic Information
| Provider Information | |||||||||
| NPI: | 1073122339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PICCICHE | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | JOSEPHINE | ||||||||
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| Credential: | MT-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1232 CHALMETTE AVE | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930035848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867190106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 611 N BRAND BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912031221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472862600 | ||||||||
| FaxNumber: | 7472040181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2020 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225A00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist |
No ID Information.