Healthcare Provider Details

I. General information

NPI: 1396765178
Provider Name (Legal Business Name): DENNIS DECICCO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N FRANKLIN TPKE
RAMSEY NJ
07446-1630
US

IV. Provider business mailing address

205 N FRANKLIN TPKE
RAMSEY NJ
07446-1630
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-7755
  • Fax: 201-461-0089
Mailing address:
  • Phone: 201-327-7755
  • Fax: 201-461-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number35S100323300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: