Provider Demographics
NPI:1407011877
Name:TICAS, NORMA LISETH
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:LISETH
Last Name:TICAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 HOLLY AVE
Mailing Address - Street 2:APT 47
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1386
Mailing Address - Country:US
Mailing Address - Phone:650-989-8640
Mailing Address - Fax:
Practice Address - Street 1:802 BREWSTER AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1510
Practice Address - Country:US
Practice Address - Phone:650-363-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health