Provider Demographics
NPI:1841440336
Name:TICA, SANDRA ANNE (MSW, LCSWR)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ANNE
Last Name:TICA
Suffix:
Gender:F
Credentials:MSW, LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BURGESS ST # 921
Mailing Address - Street 2:
Mailing Address - City:CROTON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:10519-7020
Mailing Address - Country:US
Mailing Address - Phone:201-290-7056
Mailing Address - Fax:888-972-5017
Practice Address - Street 1:3 BURGESS STREET # 921
Practice Address - Street 2:
Practice Address - City:CROTON FALLS
Practice Address - State:NY
Practice Address - Zip Code:10519-0921
Practice Address - Country:US
Practice Address - Phone:201-290-7056
Practice Address - Fax:888-972-5017
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR080156-11041C0700X
NJ44SC053634001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03567613Medicaid