Healthcare Provider Details

I. General information

NPI: 1093963639
Provider Name (Legal Business Name): JOSEPH STEPHEN CICCONE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY STE 100D
VAN NUYS CA
91405-2283
US

IV. Provider business mailing address

14600 SHERMAN WAY STE 100D
VAN NUYS CA
91405-2283
US

V. Phone/Fax

Practice location:
  • Phone: 818-374-6901
  • Fax: 818-374-6908
Mailing address:
  • Phone: 818-374-6901
  • Fax: 818-374-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number63736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: