Healthcare Provider Details

I. General information

NPI: 1912120403
Provider Name (Legal Business Name): CHRISTINE MARIA CICONE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 TOWNSGATE RD SUITE 201
WESTLAKE VILLAGE CA
91361-2710
US

IV. Provider business mailing address

2659 TOWNSGATE RD SUITE 201
WESTLAKE VILLAGE CA
91361-2710
US

V. Phone/Fax

Practice location:
  • Phone: 805-241-4439
  • Fax:
Mailing address:
  • Phone: 805-241-4439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20210
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT31271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: