MEDICARE: CAROL LYNN CILIBERTI M.A.

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	101YP2500X	Professional Counselor	PC007290	PA
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1366887150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LYNN CILIBERTI M.A.

Provider Business Mailing Address
First Line	:	322 CENTER ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3248
Country	:	US
Telephone Number	:	610-444-3127
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 CENTER ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3248
Country	:	US
Telephone Number	:	610-444-3127
Fax Number	:

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

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	06/02/2014

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