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General NPI Number Information
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NPI Number | 1093301608
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Entity Type | Individual
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Provider Name | JAMES TICKAL LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 1555 N MAITLAND AVE
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City | MAITLAND
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State | FL
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Zip | 32751-3325
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Country | US
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Telephone | 407-986-7831
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Fax |
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Provider Business Mailing Address
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Address Line | 2328 FOLIAGE OAK TER
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City | OVIEDO
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State | FL
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Zip | 32766-7021
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Country | US
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Telephone | 615-414-8294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW17870
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License Number State | FL
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