Healthcare Provider Details

I. General information

NPI: 1154876910
Provider Name (Legal Business Name): TIFFANY SICARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11564 FRANCIS LEWIS BLVD
CAMBRIA HEIGHTS NY
11411-1028
US

IV. Provider business mailing address

11564 FRANCIS LEWIS BLVD
CAMBRIA HEIGHTS NY
11411-1028
US

V. Phone/Fax

Practice location:
  • Phone: 917-648-4406
  • Fax:
Mailing address:
  • Phone: 917-648-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102970
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW6881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: