Provider Demographics
NPI:1922640382
Name:PICA, THOMAS (LMSW, CASAC 2)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PICA
Suffix:
Gender:M
Credentials:LMSW, CASAC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1612
Mailing Address - Country:US
Mailing Address - Phone:631-923-7431
Mailing Address - Fax:
Practice Address - Street 1:3408 PARK AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3702
Practice Address - Country:US
Practice Address - Phone:516-221-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY113782104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)