Healthcare Provider Details

I. General information

NPI: 1477739886
Provider Name (Legal Business Name): ANDREW THOMAS CICCHETTI L.C.S.W.-R.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 21ST ST SUITE 2E
NEW YORK NY
10010-7416
US

IV. Provider business mailing address

210 E 21ST ST SUITE 2E
NEW YORK NY
10010-7416
US

V. Phone/Fax

Practice location:
  • Phone: 212-505-6212
  • Fax:
Mailing address:
  • Phone: 212-505-6212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number051923
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: