Provider Demographics
NPI:1043703069
Name:SICILIANO, ANTONIO (LMSW)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:SICILIANO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 E LANSING DR STE 219
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2993
Mailing Address - Country:US
Mailing Address - Phone:269-350-3470
Mailing Address - Fax:
Practice Address - Street 1:1451 E LANSING DR STE 219
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2993
Practice Address - Country:US
Practice Address - Phone:269-350-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 156F00000X
MI68011140441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No156F00000XEye and Vision Services ProvidersTechnician/Technologist