Provider Demographics
NPI:1457473563
Name:SICHTA, MARTHA G (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:G
Last Name:SICHTA
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 1:811 MCCARTHY RD
Mailing Address - Street 2:
Mailing Address - City:ERIEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13061-3205
Mailing Address - Country:US
Mailing Address - Phone:315-662-7328
Mailing Address - Fax:
Practice Address - Street 1:37 N BROAD ST
Practice Address - Street 2:OFFICE #2
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1444
Practice Address - Country:US
Practice Address - Phone:607-334-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR022095-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY38743BMedicare UPIN