Healthcare Provider Details

I. General information

NPI: 1518396993
Provider Name (Legal Business Name): CICELY CISERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PARK ST
WEST SPRINGFIELD MA
01089-3314
US

IV. Provider business mailing address

21 PRINCE ST
SPRINGFIELD MA
01109-4336
US

V. Phone/Fax

Practice location:
  • Phone: 413-459-5766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: