MEDICARE: JULIE M CICILEO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	14249	CA
2	1041C0700X	Clinical Social Worker	LCS14249	CA

General Provider Information

NPI Number	:	1265636302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE M CICILEO LCSW

Provider Business Mailing Address
First Line	:	4712 E 2ND ST STE 330
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5309
Country	:	US
Telephone Number	:	562-453-8614
Fax Number	:

Provider Business Practice Location Address
First Line	:	4712 E 2ND ST STE 330
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5309
Country	:	US
Telephone Number	:	562-453-8614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	12/07/2024

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