Healthcare Provider Details

I. General information

NPI: 1841440336
Provider Name (Legal Business Name): SANDRA ANNE TICA MSW, LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BURGESS STREET # 921
CROTON FALLS NY
10519-0921
US

IV. Provider business mailing address

3 BURGESS ST # 921
CROTON FALLS NY
10519-7020
US

V. Phone/Fax

Practice location:
  • Phone: 201-290-7056
  • Fax: 888-972-5017
Mailing address:
  • Phone: 201-290-7056
  • Fax: 888-972-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR080156-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: