Provider Demographics
NPI:1619018736
Name:SICA, CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:SICA
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 1:11020 71ST RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4945
Mailing Address - Country:US
Mailing Address - Phone:718-793-3133
Mailing Address - Fax:
Practice Address - Street 1:11020 71ST RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4945
Practice Address - Country:US
Practice Address - Phone:718-793-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0373201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4156RXMedicare UPIN
NYR28067Medicare ID - Type Unspecified