Healthcare Provider Details

I. General information

NPI: 1265636302
Provider Name (Legal Business Name): JULIE M CICILEO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 E 2ND ST STE 330
LONG BEACH CA
90803-5309
US

IV. Provider business mailing address

4712 E 2ND ST STE 330
LONG BEACH CA
90803-5309
US

V. Phone/Fax

Practice location:
  • Phone: 562-453-8614
  • Fax:
Mailing address:
  • Phone: 562-453-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14249
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS14249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: