Healthcare Provider Details

I. General information

NPI: 1598871865
Provider Name (Legal Business Name): THOMAS W CICCIARELLI PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVE STE 601
SAN FRANCISCO CA
94117-3608
US

IV. Provider business mailing address

350 PARNASSUS AVE STE 601
SAN FRANCISCO CA
94117-3608
US

V. Phone/Fax

Practice location:
  • Phone: 415-767-5199
  • Fax:
Mailing address:
  • Phone: 415-767-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY17298
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY17298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: