Healthcare Provider Details

I. General information

NPI: 1508658170
Provider Name (Legal Business Name): JACQUELINE MARIA CICHONSKI MS ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NORTH ST STE 101
WHITE PLAINS NY
10605-2232
US

IV. Provider business mailing address

3 FRANKLIN AVE APT 6J
WHITE PLAINS NY
10601-3832
US

V. Phone/Fax

Practice location:
  • Phone: 914-269-2393
  • Fax:
Mailing address:
  • Phone: 646-441-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1661784221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: