Healthcare Provider Details

I. General information

NPI: 1043011919
Provider Name (Legal Business Name): CHRISTINE ROSE CICCONE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TURNPIKE ST STE 201
NORTH ANDOVER MA
01845-6156
US

IV. Provider business mailing address

1675 ROSWELL RD APT 222
MARIETTA GA
30062-3649
US

V. Phone/Fax

Practice location:
  • Phone: 978-380-8982
  • Fax:
Mailing address:
  • Phone: 978-380-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2120563
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: