Healthcare Provider Details

I. General information

NPI: 1487866141
Provider Name (Legal Business Name): RAYMOND WILLIAM CICETTI L.C.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ELM ST.
MORRISTOWN NJ
07960
US

IV. Provider business mailing address

606 ROCKAWAY TER.
MOUNTAIN LAKES NJ
07046
US

V. Phone/Fax

Practice location:
  • Phone: 973-984-6343
  • Fax:
Mailing address:
  • Phone: 973-984-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00530700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: