Healthcare Provider Details

I. General information

NPI: 1447435102
Provider Name (Legal Business Name): ELENA FICICCHIA LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COURT ST SUITE 42, COUNTY OFFICE BUILDING
NORWICH NY
13815-1695
US

IV. Provider business mailing address

5 COURT ST
NORWICH NY
13815-1695
US

V. Phone/Fax

Practice location:
  • Phone: 607-337-1602
  • Fax: 607-334-4519
Mailing address:
  • Phone: 607-337-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075730-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: