Healthcare Provider Details

I. General information

NPI: 1831267616
Provider Name (Legal Business Name): CAROLYN B SICHER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL BOX 1230
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

177 E 77TH ST APT 4C
NEW YORK NY
10075-1934
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8838
  • Fax: 212-996-8931
Mailing address:
  • Phone: 917-363-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number002691
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: