Healthcare Provider Details

I. General information

NPI: 1346398757
Provider Name (Legal Business Name): ROBERT MICHAEL CICIONE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 ATWOOD AVE CROSSROAD COMMONS SUITE 209
JOHNSTON RI
02919
US

IV. Provider business mailing address

1395 ATWOOD AVE CROSSROAD COMMONS SUITE 209
JOHNSTON RI
02919
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-7667
  • Fax: 401-944-8222
Mailing address:
  • Phone: 401-943-7667
  • Fax: 401-944-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW00503
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: