Provider Demographics
NPI:1255732566
Name:SICILIANO, STELLA (LCSW)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:SICILIANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 KENTUCKY WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4653
Mailing Address - Country:US
Mailing Address - Phone:732-688-4911
Mailing Address - Fax:
Practice Address - Street 1:45 E MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2270
Practice Address - Country:US
Practice Address - Phone:732-462-7877
Practice Address - Fax:732-462-7879
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-07
Last Update Date:2014-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056020001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical