Provider Demographics
NPI:1457649980
Name:SICKLES, LISA G (LMFT LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:G
Last Name:SICKLES
Suffix:
Gender:F
Credentials:LMFT LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-0721
Mailing Address - Country:US
Mailing Address - Phone:518-380-6786
Mailing Address - Fax:518-252-4253
Practice Address - Street 1:267 TAMPA AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1224
Practice Address - Country:US
Practice Address - Phone:518-380-6786
Practice Address - Fax:518-252-4253
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004963101YM0800X
VA0717001952106H00000X
NY000886106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health