Healthcare Provider Details

I. General information

NPI: 1194260398
Provider Name (Legal Business Name): CHLOE FICO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E. 23RD ST. DVA
NEW YORK NY
10010
US

IV. Provider business mailing address

116 JOHN ST APT 703
NEW YORK NY
10038-5612
US

V. Phone/Fax

Practice location:
  • Phone: 191-795-2289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number097755
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: