Provider Demographics
NPI:1497207971
Name:TICCO, ANDON
Entity Type:Individual
Prefix:
First Name:ANDON
Middle Name:
Last Name:TICCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANDON
Other - Middle Name:
Other - Last Name:TICCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:1530 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1263
Mailing Address - Country:US
Mailing Address - Phone:716-389-1008
Mailing Address - Fax:
Practice Address - Street 1:1530 MILITARY RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1263
Practice Address - Country:US
Practice Address - Phone:716-389-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008540101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty