Individual provider Active NPI

Jessica Tylicki, PHD

  • Clinical Psychologist
  • Boca Raton, FL
National Provider Identifier
1104550490
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY11524 Issued in FL
Practice address
7000 W Palmetto Park Rd Ste 201
Boca Raton, FL 33433-3430
Phone
(561) 732-2000
NPI assigned
Jul 12, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PY11524 FL
Psychologist 103T00000X PY11524 FL
Clinical Psychologist 103TC0700X PY11524 FL Primary

Addresses

Primary practice location

7000 W Palmetto Park Rd Ste 201
Boca Raton, FL 33433-3430

Mailing address

1601 Clint Moore Rd Ste 120
Boca Raton, FL 33487-5712
Phone (561) 732-7000

Other practice location 1

1601 Clint Moore Rd Ste 120
Boca Raton, FL 33487-5712
Phone (561) 732-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY11524FLMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Psychological Assessment Services, LLC Clinical Neuropsychologist Current Accepting new patients
Different Like Me Inc PastSince Nov 12, 2023 Accepting new patients

Locations

1601 Clint Moore Rd
Ste 120
Boca Raton, FL 33487
Phone (561) 270-2280

7000 W Palmetto Park Rd
Ste 201
Boca Raton, FL 33433
Phone (561) 270-2280

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1104550490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CLINT MOORE RD STE 120",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334875712",
            "telephone_number": "561-732-7000",
            "fax_number": "561-731-2997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 W PALMETTO PARK RD STE 201",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334333430",
            "telephone_number": "561-732-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 Clint Moore Rd Ste 120",
            "address_purpose": "LOCATION",
            "city": "Boca Raton",
            "state": "FL",
            "postal_code": "334875712",
            "country_code": "US",
            "telephone_number": "561-732-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TYLICKI",
        "first_name": "JESSICA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-12",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY11524",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY11524",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY11524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.