Provider Demographics
NPI:1750851242
Name:TICEN, SANDRA MARIA (MS, LCAT, CAS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIA
Last Name:TICEN
Suffix:
Gender:F
Credentials:MS, LCAT, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GREENMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4611
Mailing Address - Country:US
Mailing Address - Phone:716-633-2885
Mailing Address - Fax:
Practice Address - Street 1:9070 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1825
Practice Address - Country:US
Practice Address - Phone:716-632-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health