Provider Demographics
NPI:1437568763
Name:FICO, JANE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:FICO
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 1:50 CANTERBURY WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-2411
Mailing Address - Country:US
Mailing Address - Phone:315-391-6246
Mailing Address - Fax:
Practice Address - Street 1:742 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2017
Practice Address - Country:US
Practice Address - Phone:315-703-2700
Practice Address - Fax:315-703-2880
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0842171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical