Provider Demographics
NPI:1790270940
Name:SIKORA, MARY ELIZEBETH (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZEBETH
Last Name:SIKORA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 IRVING RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3428
Mailing Address - Country:US
Mailing Address - Phone:229-894-1525
Mailing Address - Fax:
Practice Address - Street 1:2200 LAKESHORE DR STE 150
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-8832
Practice Address - Country:US
Practice Address - Phone:205-871-6926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4124C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical