Healthcare Provider Details

I. General information

NPI: 1962732404
Provider Name (Legal Business Name): DELAINA LORRENE FICO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 BRIGHTON HENRIETTA TOWN LINE RD
ROCHESTER NY
14623-2792
US

IV. Provider business mailing address

1173 HIDDEN VALLEY TRL
WEBSTER NY
14580-9133
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-0661
  • Fax:
Mailing address:
  • Phone: 585-271-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number080651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: