MR. Emilio Licea III, PSYD
NPI #1336496710 in Sebastopol, California
Provider Information
- NPI Number
- 1336496710
- Entity Type
- Individual
- Name
- MR. Emilio Licea III, PSYD
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Psychologist - Clinical
- Credential
- PSYD
- Enumeration Date
- Aug 5, 2012
- Last Updated
- Dec 30, 2021
Practice Location
- Address
- 652 PETALUMA AVE
- City
- Sebastopol
- State
- California
- ZIP Code
- 95472-4256
- Phone
- (707) 823-3166
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychologist - Clinical — Clinical |
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