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General NPI Number Information
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NPI Number | 1457488322
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Entity Type | Individual
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Provider Name | LISA MICHELE CICCARELLI M.F.T., M.S.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 135 E 3RD AVE SUITE B
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City | ESCONDIDO
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State | CA
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Zip | 92025-4252
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Country | US
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Telephone | 760-737-9694
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Fax | 760-747-5474
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Provider Business Mailing Address
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Address Line | 1027 CRIMSON DR
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City | SAN MARCOS
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State | CA
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Zip | 92069-1193
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Country | US
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Telephone | 760-510-1744
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Fax | 760-510-1744
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 31473
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License Number State | CA
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