=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801321880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ALYCE CISINE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2017
-----------------------------------------------------
Last Update Date | 05/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 654 WARNER RD
-----------------------------------------------------
City | HUBBARD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44425-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-729-5358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 654 WARNER RD
-----------------------------------------------------
City | HUBBARD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44425-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-729-5358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST / MANAGER
-----------------------------------------------------
Name | ALYCE CISINE
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 330-729-5358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6848
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------