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General NPI Number Information
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NPI Number | 1205964426
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Entity Type | Individual
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Provider Name | LORI LYNN CICCONE PA
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Gender | Female
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 12/08/2023
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Provider Practice Location Address
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Address Line | 350 GOOSE LN STE 203B
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City | GUILFORD
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State | CT
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Zip | 06437-2492
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Country | US
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Telephone | 203-932-6481
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Fax | 39-324-0512
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Provider Business Mailing Address
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Address Line | 322 E MAIN ST STE 1B
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City | BRANFORD
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State | CT
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Zip | 06405-3136
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Country | US
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Telephone | 34-887-2282
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Fax | 203-204-1415
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001888
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001888
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License Number State | CT
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