Healthcare Provider Details

I. General information

NPI: 1669833703
Provider Name (Legal Business Name): ASHLEY CICCARELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WHITE HORSE PIKE
HADDON HEIGHTS NJ
08035-1703
US

IV. Provider business mailing address

101 ATLANTIC AVE
VOORHEES NJ
08043-1214
US

V. Phone/Fax

Practice location:
  • Phone: 856-617-4544
  • Fax:
Mailing address:
  • Phone: 617-279-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05779700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05828300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: