Provider Demographics
NPI:1558985374
Name:LICCHIO, MARGARET MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARY
Last Name:LICCHIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:NICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:19 BULLARD DR
Mailing Address - Street 2:
Mailing Address - City:LAVALLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:08735-2803
Mailing Address - Country:US
Mailing Address - Phone:732-266-5257
Mailing Address - Fax:
Practice Address - Street 1:36 W WATER ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7414
Practice Address - Country:US
Practice Address - Phone:732-349-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC049186001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical