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Contact Information

EMILIO LICEA III, PSYD
652 PETALUMA AVE
SEBASTOPOL, CA95472-4256
 Phone: 707-823-3166
 Fax: 707-869-8170
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for EMILIO LICEA III · (Male)

NPI Number 1336496710
Status Active
Credentials PSYD (Doctor of Psychology)
Entity Individual
Enumeration date 08/05/2012
Last updated 12/30/2021 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • CA License # PSY29447
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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