MR. EMILIO LICEA III PSYD
NPI 1336496710
Psychologist - Clinical in Sebastopol, CA

Q: What is Emilio Licea's NPI number?

The NPI number for Emilio Licea is 1336496710. It was assigned to this individual provider in the NPPES registry on August 5, 2012.

Q: What is Emilio Licea's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Emilio Licea was last updated on December 30, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since August 05, 2012PECOS Enrolled

652 PETALUMA AVE, SEBASTOPOL, CA 95472(707) 823-3166(707) 869-8170 Get Directions Write a Review

NPPES record last updated: December 30, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 30, 2021, Dec 20, 2018 (2 updates tracked since 2018).

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About Mr. Emilio Licea Iii Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. EMILIO LICEA III PSYD (NPI 1336496710) is an individual clinical provider in Sebastopol, California, licensed in California (PSY29447) and active in the NPI registry since August 2012. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1336496710

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameMR. EMILIO LICEA IIICredential: PSYD

Location Address652 PETALUMA AVESebastopol, CA 95472-4256

Mailing AddressPo Box 1449Guerneville, CA 95446-1449 · (707) 869-5977 · Fax (707) 869-5976

Phone(707) 823-3166

Fax(707) 869-8170

Sole ProprietorNo

Enumeration DateAugust 5, 2012

Last NPPES UpdateDecember 30, 20212 updates tracked since enumeration

✔ NPI 1336496710 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in CA · PSY29447

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

652 PETALUMA AVE, Sebastopol, CA 95472

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Emilio Licea Iii Psyd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95472 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$187.01 typical visit price

range $63.04 – $187.01

Typical copayment $46.75 (range $15.76 – $46.75)

Most-billed visit code 99205

Established Patient

$109.88 typical visit price

range $21.02 – $153.40

Typical copayment $27.47 (range $5.25 – $38.35)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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