Provider Demographics
NPI:1760677801
Name:BICE, WILLARD JAMES
Entity Type:Individual
Prefix:MR
First Name:WILLARD
Middle Name:JAMES
Last Name:BICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 LERAY ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1313
Mailing Address - Country:US
Mailing Address - Phone:315-728-1328
Mailing Address - Fax:
Practice Address - Street 1:814 LERAY ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1313
Practice Address - Country:US
Practice Address - Phone:315-728-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health