Provider Demographics
NPI:1477982189
Name:SICILIANO-HARTT, SARAH MARKS (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARKS
Last Name:SICILIANO-HARTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARKS
Other - Last Name:SICILIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1050 NW 15TH ST
Mailing Address - Street 2:SUITE 111-A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1375
Mailing Address - Country:US
Mailing Address - Phone:561-338-4700
Mailing Address - Fax:561-338-0536
Practice Address - Street 1:1050 NW 15TH ST
Practice Address - Street 2:SUITE 111-A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1375
Practice Address - Country:US
Practice Address - Phone:561-338-4700
Practice Address - Fax:561-338-0536
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist