Healthcare Provider Details

I. General information

NPI: 1205009537
Provider Name (Legal Business Name): DR. CRISTINA LAURA CIOCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 803
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

5 PORTAGE XING
FARMINGTON CT
06032-2737
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-4136
  • Fax: 860-545-4009
Mailing address:
  • Phone: 860-677-4693
  • Fax: 860-545-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number002035
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: