Provider Demographics
NPI:1700929569
Name:SICLARE, TERRI MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:MARY
Last Name:SICLARE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7508
Mailing Address - Country:US
Mailing Address - Phone:973-993-1990
Mailing Address - Fax:973-898-3745
Practice Address - Street 1:43 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7508
Practice Address - Country:US
Practice Address - Phone:973-993-1990
Practice Address - Fax:973-898-3745
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3260103T00000X
PA15656103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50062844OtherCAPITAL BLUE CROSS
PA806024OtherHIGHMARK BLUE SHIELD