Provider Demographics
NPI:1114159217
Name:SICA, THERESA A (LICSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:SICA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NEW DRIFTWAY
Mailing Address - Street 2:SUITE 105-G
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-4546
Mailing Address - Country:US
Mailing Address - Phone:781-561-5264
Mailing Address - Fax:
Practice Address - Street 1:10 NEW DRIFTWAY
Practice Address - Street 2:SUITE 105-G
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4546
Practice Address - Country:US
Practice Address - Phone:781-561-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-23
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1114611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical