Healthcare Provider Details

I. General information

NPI: 1457546152
Provider Name (Legal Business Name): PATRICIA L CICETTI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 MIMOSA PL
BOYNTON BEACH FL
33472-5020
US

IV. Provider business mailing address

8130 MIMOSA PL
BOYNTON BEACH FL
33472-5020
US

V. Phone/Fax

Practice location:
  • Phone: 561-502-1638
  • Fax: 561-740-4788
Mailing address:
  • Phone: 561-502-1638
  • Fax: 561-740-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC#6454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: