Provider Demographics
NPI:1649368283
Name:JOSEPH, SICILY NONE (PHD)
Entity type:Individual
Prefix:DR
First Name:SICILY
Middle Name:NONE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SICILY
Other - Middle Name:
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:128 E KATELLA AVE
Mailing Address - Street 2:110
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-4836
Mailing Address - Country:US
Mailing Address - Phone:714-287-8973
Mailing Address - Fax:
Practice Address - Street 1:128 E KATELLA AVE
Practice Address - Street 2:110
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-4836
Practice Address - Country:US
Practice Address - Phone:714-287-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical