Provider Demographics
NPI:1508519190
Name:LICAUSI, ANN MARIE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:ELIZABETH
Last Name:LICAUSI
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 1:5862 FOREST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1963
Mailing Address - Country:US
Mailing Address - Phone:716-228-1253
Mailing Address - Fax:
Practice Address - Street 1:5862 FOREST CREEK DR
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1963
Practice Address - Country:US
Practice Address - Phone:716-228-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0881451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical