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General NPI Number Information
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NPI Number | 1457649980
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Entity Type | Individual
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Provider Name | LISA G. SICKLES LMFT LMHC
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Gender | Female
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 267 TAMPA AVE
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City | ALBANY
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State | NY
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Zip | 12208-1224
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Country | US
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Telephone | 518-380-6786
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Fax | 518-252-4253
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Provider Business Mailing Address
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Address Line | PO BOX 721
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City | SLINGERLANDS
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State | NY
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Zip | 12159-0721
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Country | US
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Telephone | 518-380-6786
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Fax | 518-252-4253
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 004963
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717001952
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000886
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License Number State | NY
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