Healthcare Provider Details

I. General information

NPI: 1336233923
Provider Name (Legal Business Name): MARK JOHN CIOCCA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CENTRE STREET SUITE 2
CONCORD NH
03301-6302
US

IV. Provider business mailing address

8 CENTRE STREET SUITE 2
CONCORD NH
03301-6302
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7300
  • Fax: 603-228-7301
Mailing address:
  • Phone: 603-228-7300
  • Fax: 603-228-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number395
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: