Healthcare Provider Details

I. General information

NPI: 1801398003
Provider Name (Legal Business Name): CICARELLI COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 WILES RD, SUITE 107
CORAL SPRINGS FL
33067-4105
US

IV. Provider business mailing address

7301 WILES RD, SUITE 107
CORAL SPRINGS FL
33067-4105
US

V. Phone/Fax

Practice location:
  • Phone: 954-478-8568
  • Fax:
Mailing address:
  • Phone: 954-478-8568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSW8036
License Number StateFL

VIII. Authorized Official

Name: MAGDALENA CICARELLI
Title or Position: PSYCOTHERAPIST / OWNER
Credential: LCSW
Phone: 954-478-8568