Provider Demographics
NPI:1629183298
Name:SICILIA, JUDY (PSY D)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:SICILIA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 MATTHEW DR
Mailing Address - Street 2:UNIT F
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1702
Mailing Address - Country:US
Mailing Address - Phone:239-275-9989
Mailing Address - Fax:239-277-1993
Practice Address - Street 1:1560 MATTHEW DR
Practice Address - Street 2:UNIT F
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1702
Practice Address - Country:US
Practice Address - Phone:239-275-9989
Practice Address - Fax:239-277-1993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4797103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY318-6315OtherGHI
59386OtherBLUE CROSS BLUE SHIELD
083038OtherVALUE OPTIONS
3073204OtherHEALTH PARTNERS
59386OtherBLUE CROSS BLUE SHIELD