Healthcare Provider Details

I. General information

NPI: 1821502220
Provider Name (Legal Business Name): DANIEL CICCARELLO LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CARNEGIE AVE
CLEVELAND OH
44115-2641
US

IV. Provider business mailing address

3500 CARNEGIE AVE
CLEVELAND OH
44115-2641
US

V. Phone/Fax

Practice location:
  • Phone: 216-318-7872
  • Fax:
Mailing address:
  • Phone: 216-318-7872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1802501
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: