Provider Demographics
NPI:1083080360
Name:SICA, CHLOE JAYNE HAAZ (PSYD)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:JAYNE HAAZ
Last Name:SICA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 COMMERCE DR STE 115
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2600
Mailing Address - Country:US
Mailing Address - Phone:215-309-9155
Mailing Address - Fax:
Practice Address - Street 1:390 COMMERCE DR STE 115
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2600
Practice Address - Country:US
Practice Address - Phone:215-309-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022747103TC0700X
NJ35SI00615200103TC0700X
390200000X
PAPS019576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program