Healthcare Provider Details

I. General information

NPI: 1679091326
Provider Name (Legal Business Name): SARA R CICCHINELLI LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7519 MENTOR AVE STE 211
MENTOR OH
44060-5434
US

IV. Provider business mailing address

7389 N CHESTNUT COMMONS DR
MENTOR OH
44060-3540
US

V. Phone/Fax

Practice location:
  • Phone: 440-701-6170
  • Fax:
Mailing address:
  • Phone: 330-760-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1901289
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC.1400204
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: