Healthcare Provider Details

I. General information

NPI: 1730381773
Provider Name (Legal Business Name): CICCONE COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S FULLERTON AVE
MONTCLAIR NJ
07042-6304
US

IV. Provider business mailing address

11 S FULLERTON AVE
MONTCLAIR NJ
07042-6304
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-8400
  • Fax:
Mailing address:
  • Phone: 973-744-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04532400
License Number StateNJ

VIII. Authorized Official

Name: DONNA MARIE CICCONE
Title or Position: DIRECTOR
Credential: LCSW
Phone: 973-744-8400