Healthcare Provider Details

I. General information

NPI: 1639395395
Provider Name (Legal Business Name): JOAN M CICCHIELLO PHD, PMHNP, B-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 5TH ST
MOUNT CARMEL PA
17851-1803
US

IV. Provider business mailing address

35 WEST AVE
MOUNT CARMEL PA
17851-1303
US

V. Phone/Fax

Practice location:
  • Phone: 570-875-8058
  • Fax: 570-554-4357
Mailing address:
  • Phone: 570-875-8058
  • Fax: 570-554-4357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberTP006931C
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP009838
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberSP009838
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: