Healthcare Provider Details

I. General information

NPI: 1760797070
Provider Name (Legal Business Name): ELIZABETH JANE SILLICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90-27 SUTPHIN BLVD, 5TH FLOOR TRANSITIONAL SERVICES OF NEW YORK
JAMAICA NY
11435
US

IV. Provider business mailing address

90-27 SUTPHIN BLVD, 5TH FLOOR TRANSITIONAL SERVICES OF NEW YORK
JAMAICA NY
11435
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax: 718-297-8658
Mailing address:
  • Phone: 718-526-8400
  • Fax: 718-297-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number72 080078
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081420-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: