| Doctor Name: | DR. SCOTT DAVID CICERO |
| NPI Number: | 1083925598 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 011369 |
| Business Practice Address: | 2 First Ave. Orangeburg, NY - 10962 |
| Business Phone Number: | 8456804024 |
| Business Fax Number: | 8456808905 |
| Mailing Address: | 140 Old Orangeburg Rd, Building 35 ORANGEBURG |
| State: | NY |
| Postal Code: | 109621157 |
| Phone Number: | 8453982190 |
| Fax Number: | 8453986592 |
| NPI Enumeration Date: | 06/30/2010 |
| NPI Last Update Date: | 05/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 011369 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |