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General NPI Number Information
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NPI Number | 1043011919
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Entity Type | Individual
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Provider Name | CHRISTINE ROSE CICCONE MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 800 TURNPIKE ST STE 201
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City | NORTH ANDOVER
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State | MA
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Zip | 01845-6156
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Country | US
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Telephone | 978-380-8982
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 ROSWELL RD APT 222
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City | MARIETTA
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State | GA
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Zip | 30062-3649
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Country | US
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Telephone | 978-380-8982
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW2120563
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License Number State | MA
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