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General NPI Number Information
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NPI Number | 1083925598
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Entity Type | Individual
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Provider Name | SCOTT DAVID CICERO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 2 FIRST AVE.
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City | ORANGEBURG
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State | NY
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Zip | 10962
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Country | US
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Telephone | 845-680-4024
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Fax | 845-680-8905
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Provider Business Mailing Address
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Address Line | 140 OLD ORANGEBURG RD BUILDING 35
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City | ORANGEBURG
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State | NY
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Zip | 10962-1157
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Country | US
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Telephone | 845-398-2190
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Fax | 845-398-6592
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 011369
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License Number State | NY
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