Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Emilio Licea III, PSYD

Individual provider Clinical Psychologist · NPI 1336496710

Mr. Emilio Licea III, PSYD is a Clinical Psychologist in Sebastopol, California. Licensed in California. Registered with an NPI since 2012.

Licensed in
CA
In the registry since
2012
What do these letters mean?
PSYD — Doctor of Psychology
A doctoral psychologist trained primarily for clinical practice.

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Practice location Address checks out

652 Petaluma Ave
Sebastopol, CA 95472-4256
Phone: (707) 823-3166
Fax: (707) 869-8170
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence PSY29447 (CA)

Record details

NPI number1336496710
Entity typeIndividual (Type 1)
GenderMale
Credentials PSYD
Sole proprietorNo
NPI enumeratedAugust 5, 2012
Last updated in NPPESDecember 30, 2021

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