Healthcare Provider Details

I. General information

NPI: 1538503818
Provider Name (Legal Business Name): LAUREN MARIE CICCONE MS, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 US HIGHWAY 9
BEACHWOOD NJ
08722-4007
US

IV. Provider business mailing address

625 US HIGHWAY 9
BEACHWOOD NJ
08722-4007
US

V. Phone/Fax

Practice location:
  • Phone: 732-344-0882
  • Fax:
Mailing address:
  • Phone: 732-344-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00544900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: