Provider Demographics
NPI:1962732404
Name:FICO, DELAINA LORRENE (LMSW)
Entity type:Individual
Prefix:
First Name:DELAINA
Middle Name:LORRENE
Last Name:FICO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 HIDDEN VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9133
Mailing Address - Country:US
Mailing Address - Phone:585-271-0661
Mailing Address - Fax:
Practice Address - Street 1:2060 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2792
Practice Address - Country:US
Practice Address - Phone:585-271-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker