Basic Information
| Provider Information | |||||||||
| NPI: | 1760797070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILLICK | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90-27 SUTPHIN BLVD, 5TH FLOOR | ||||||||
| Address2: | TRANSITIONAL SERVICES OF NEW YORK | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185268400 | ||||||||
| FaxNumber: | 7182978658 | ||||||||
| Practice Location | |||||||||
| Address1: | 90-27 SUTPHIN BLVD, 5TH FLOOR | ||||||||
| Address2: | TRANSITIONAL SERVICES OF NEW YORK | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185268400 | ||||||||
| FaxNumber: | 7182978658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2010 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 72 080078 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 081420-01 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.