Healthcare Provider Details

I. General information

NPI: 1902039100
Provider Name (Legal Business Name): JUNE A. CICHOWICZ MSSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL PKWY STE 860B
SAN JOSE CA
95119-1145
US

IV. Provider business mailing address

275 HOSPITAL PKWY STE 860B
SAN JOSE CA
95119-1145
US

V. Phone/Fax

Practice location:
  • Phone: 408-362-3694
  • Fax: 408-972-6759
Mailing address:
  • Phone: 408-362-3694
  • Fax: 408-972-6759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: