Doctor Name: | MS. MARHENRA J CICCONE |
NPI Number: | 1417012113 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CRC |
License Number: | 002935 |
Business Practice Address: | 8748 Weaver Rd Brewerton, NY - 130299690 |
Business Phone Number: | 3156992925 |
Business Fax Number: | 3156992925 |
Mailing Address: | 8748 Weaver Rd, BREWERTON |
State: | NY |
Postal Code: | 130299690 |
Phone Number: | 3156992925 |
Fax Number: | 3156992925 |
NPI Enumeration Date: | 12/25/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 002935 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |