Healthcare Provider Details

I. General information

NPI: 1902527369
Provider Name (Legal Business Name): MR. PAUL CICCHINI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 12TH ST
WILMINGTON DE
19801-3403
US

IV. Provider business mailing address

401 E 12TH ST
WILMINGTON DE
19801-3403
US

V. Phone/Fax

Practice location:
  • Phone: 302-571-5431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: