Provider Demographics
NPI:1023169430
Name:SICHEL, MARK (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SICHEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 54TH ST
Mailing Address - Street 2:APT 15A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5179
Mailing Address - Country:US
Mailing Address - Phone:212-644-4947
Mailing Address - Fax:212-644-4948
Practice Address - Street 1:420 E 54TH ST
Practice Address - Street 2:APT 15A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5179
Practice Address - Country:US
Practice Address - Phone:212-644-4947
Practice Address - Fax:212-644-4948
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025394-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN01832Medicare UPIN