Provider Demographics
NPI:1053693648
Name:KLARICH, AMY J (MA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:KLARICH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5612 43RD ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-5506
Mailing Address - Country:US
Mailing Address - Phone:941-744-6155
Mailing Address - Fax:
Practice Address - Street 1:505 E JACKSON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4989
Practice Address - Country:US
Practice Address - Phone:813-375-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health