1841440336 NPI number — MS. SANDRA ANNE TICA MSW, LCSWR

Table of content: MS. SANDRA ANNE TICA MSW, LCSWR (NPI 1841440336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841440336 NPI number — MS. SANDRA ANNE TICA MSW, LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TICA
Provider First Name:
SANDRA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSWR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841440336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 BURGESS ST # 921
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROTON FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10519-7020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-290-7056
Provider Business Mailing Address Fax Number:
888-972-5017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 BURGESS STREET # 921
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROTON FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10519-0921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-290-7056
Provider Business Practice Location Address Fax Number:
888-972-5017
Provider Enumeration Date:
09/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R080156-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03567613 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".