MEDICARE: CHLOE JAYNE HAAZ SICA PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	022747	NY
2	103TC0700X	Clinical Psychologist	35SI00615200	NJ
3	390200000X	Student in an Organized Health Care Education/Training Program
4	103TC0700X	Clinical Psychologist	PS019576	PA

General Provider Information

NPI Number	:	1083080360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHLOE JAYNE HAAZ SICA PSY.D

Provider Business Mailing Address
First Line	:	390 COMMERCE DR STE 115
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-2600
Country	:	US
Telephone Number	:	215-309-9155
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 COMMERCE DR STE 115
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-2600
Country	:	US
Telephone Number	:	215-309-9155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	03/21/2023

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