Provider Demographics
NPI:1790111417
Name:SICILIA-MACRINA, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SICILIA-MACRINA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SICILIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, MSW
Mailing Address - Street 1:1355 OLD YORK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3413
Mailing Address - Country:US
Mailing Address - Phone:215-906-7207
Mailing Address - Fax:
Practice Address - Street 1:1355 OLD YORK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3413
Practice Address - Country:US
Practice Address - Phone:215-906-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123761104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker