Provider Demographics
NPI:1083247811
Name:SCALICI, SYDNEY SMITH (LMHC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:SMITH
Last Name:SCALICI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1202
Mailing Address - Country:US
Mailing Address - Phone:607-437-8338
Mailing Address - Fax:
Practice Address - Street 1:82 BEAVER ST
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1202
Practice Address - Country:US
Practice Address - Phone:607-437-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health