Doctor Name: | ADAM CICCIO |
NPI Number: | 1346597283 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | |
Business Practice Address: | 70 Atlantic Avenue Unit 8 Marblehead, MA - 01945 |
Business Phone Number: | 7813070098 |
Business Fax Number: | |
Mailing Address: | 70 Atlantic Ave, Unit 8 MARBLEHEAD |
State: | MA |
Postal Code: | 019453042 |
Phone Number: | 7813070098 |
Fax Number: | |
NPI Enumeration Date: | 08/09/2012 |
NPI Last Update Date: | 12/05/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |