Provider Demographics
NPI:1174955207
Name:AMELIA PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:AMELIA PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BICKNELL
Authorized Official - Suffix:III
Authorized Official - Credentials:PSYD
Authorized Official - Phone:904-432-7833
Mailing Address - Street 1:1890 S 14TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4740
Mailing Address - Country:US
Mailing Address - Phone:904-432-7833
Mailing Address - Fax:904-432-7831
Practice Address - Street 1:1890 S 14TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4740
Practice Address - Country:US
Practice Address - Phone:904-432-7833
Practice Address - Fax:904-432-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty