Provider Demographics
NPI:1487047445
Name:AMICY, ISABEL (MS)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:AMICY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14629 SW 104TH ST STE 129
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2905
Mailing Address - Country:US
Mailing Address - Phone:786-231-4774
Mailing Address - Fax:
Practice Address - Street 1:2000 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2456
Practice Address - Country:US
Practice Address - Phone:786-231-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH12027101YM0800X
FLIMT2058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist