Provider Demographics
NPI:1972196954
Name:VICIK, EMILY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:VICIK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:TESS
Other - Middle Name:
Other - Last Name:VICIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:3901 GENESEE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1954
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 GENESEE ST STE 110
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1954
Practice Address - Country:US
Practice Address - Phone:716-842-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker