Healthcare Provider Details

I. General information

NPI: 1174495519
Provider Name (Legal Business Name): AMANDA CICCHETTI LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N MAIN ST
DAYVILLE CT
06241-2170
US

IV. Provider business mailing address

164 ORCHARD HILL RD
POMFRET CENTER CT
06259-2107
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-2020
  • Fax: 860-774-0826
Mailing address:
  • Phone: 860-774-2020
  • Fax: 860-774-0826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10106
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: