Healthcare Provider Details

I. General information

NPI: 1952449647
Provider Name (Legal Business Name): LYNN NOELLE CICCONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 GARDENVILLE PKWY W
WEST SENECA NY
14224-1324
US

IV. Provider business mailing address

800 CARTER ST
ROCHESTER NY
14621-2604
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-3600
  • Fax: 716-656-4223
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number016312-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: