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General NPI Number Information
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NPI Number | 1790165553
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Entity Type | Organization
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Legal Business Name | CICCHIELLO CORPORATION INC
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 06/05/2015
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Provider Practice Location Address
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Address Line | 601 W 5TH ST
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City | MOUNT CARMEL
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State | PA
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Zip | 17851-1803
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Country | US
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Telephone | 570-875-8058
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Fax |
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Provider Business Mailing Address
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Address Line | 601 W 5TH ST
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City | MOUNT CARMEL
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State | PA
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Zip | 17851-1803
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Country | US
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Telephone | 570-875-8058
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOAN M CICCHIELLO
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Credential | PMHNP
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Telephone | 570-875-8058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | TP006931C
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP009838
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License Number State | PA
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