Healthcare Provider Details

I. General information

NPI: 1407492655
Provider Name (Legal Business Name): DEANNA MARIE VAN SICKLE MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEANNA MARIE MASCIA MSW LSW

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 S HIGH ST
COLUMBUS OH
43215-5602
US

IV. Provider business mailing address

527 S HIGH ST
COLUMBUS OH
43215-5602
US

V. Phone/Fax

Practice location:
  • Phone: 614-487-8758
  • Fax:
Mailing address:
  • Phone: 614-487-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608134
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: