Provider Demographics
NPI:1093910010
Name:LICO, VERONICA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:LICO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 WINDHAM CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1645
Mailing Address - Country:US
Mailing Address - Phone:609-688-9843
Mailing Address - Fax:
Practice Address - Street 1:106 HAGERMAN COURT
Practice Address - Street 2:SENIOR PSYCHOLOGICAL CARE
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-243-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052843001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05284300OtherLCSW