MEDICARE: DR. PATRICIA L CICETTI LMHC

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	101YM0800X	Mental Health Counselor	LMHC#6454	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6454	OTHER	FL	LMHC

General Provider Information

NPI Number	:	1457546152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA L CICETTI LMHC

Provider Business Mailing Address
First Line	:	8130 MIMOSA PL
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-5020
Country	:	US
Telephone Number	:	561-502-1638
Fax Number	:	561-740-4788

Provider Business Practice Location Address
First Line	:	8130 MIMOSA PL
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-5020
Country	:	US
Telephone Number	:	561-502-1638
Fax Number	:	561-740-4788

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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