Provider Demographics
NPI:1053726570
Name:KALICINSKI, SYLVIA JESSICA
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:JESSICA
Last Name:KALICINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BISCAYNE BLVD APT 1807
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2932
Mailing Address - Country:US
Mailing Address - Phone:805-280-9155
Mailing Address - Fax:
Practice Address - Street 1:50 BISCAYNE BLVD APT 1807
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2932
Practice Address - Country:US
Practice Address - Phone:805-280-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist