Healthcare Provider Details

I. General information

NPI: 1164449021
Provider Name (Legal Business Name): MARSHA K CICCONE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 NE 45TH ST SUITE 210
FORT LAUDERDALE FL
33308-5199
US

IV. Provider business mailing address

1905 N OCEAN BLVD APT. 14D
FORT LAUDERDALE FL
33305-3747
US

V. Phone/Fax

Practice location:
  • Phone: 954-383-3619
  • Fax: 954-563-9530
Mailing address:
  • Phone: 954-383-3619
  • Fax: 954-563-9530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: