Provider Demographics
NPI:1073122339
Name:PICCICHE, AMANDA JOSEPHINE (MT-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOSEPHINE
Last Name:PICCICHE
Suffix:
Gender:
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 CHALMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5848
Mailing Address - Country:US
Mailing Address - Phone:586-719-0106
Mailing Address - Fax:
Practice Address - Street 1:333 SKYWAY DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8552
Practice Address - Country:US
Practice Address - Phone:805-504-1155
Practice Address - Fax:805-383-1134
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist