Provider Demographics
NPI:1255451928
Name:LOUCA, SIRKA (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:SIRKA
Middle Name:
Last Name:LOUCA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0463
Mailing Address - Country:US
Mailing Address - Phone:631-689-2582
Mailing Address - Fax:
Practice Address - Street 1:384 MARK TREE RD
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1002
Practice Address - Country:US
Practice Address - Phone:631-689-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050473-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical