Provider Demographics
NPI:1184812026
Name:SICKLES, CATHERINE C (LCMHC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:SICKLES
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:C
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03455-0125
Mailing Address - Country:US
Mailing Address - Phone:603-400-7472
Mailing Address - Fax:
Practice Address - Street 1:800 PARK AVE RM 111
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1513
Practice Address - Country:US
Practice Address - Phone:603-400-7472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3124965Medicaid