Healthcare Provider Details

I. General information

NPI: 1568785582
Provider Name (Legal Business Name): ANNE ELIZABETH CICCONE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 06/25/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PROSPECT HTS
NORTHAMPTON MA
01060-1612
US

IV. Provider business mailing address

9 PROSPECT HTS
NORTHAMPTON MA
01060-1612
US

V. Phone/Fax

Practice location:
  • Phone: 504-357-9072
  • Fax:
Mailing address:
  • Phone: 504-357-9072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1214
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11294
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: