Healthcare Provider Details

I. General information

NPI: 1003945379
Provider Name (Legal Business Name): DANIEL CHARLES CICCONI LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EUGENE CIR
MILFORD MA
01757-2136
US

IV. Provider business mailing address

1 EUGENE CIR
MILFORD MA
01757-2136
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-3230
  • Fax:
Mailing address:
  • Phone: 508-879-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1072
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: