MEDICARE: SARA R CICCHINELLI LPCC

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	251S00000X	Community/Behavioral Health Agency	C.1400204	OH
2	101YP2500X	Professional Counselor	E.1901289	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679091326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA R CICCHINELLI LPCC

Provider Business Mailing Address
First Line	:	7389 N CHESTNUT COMMONS DR
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-3540
Country	:	US
Telephone Number	:	330-760-1666
Fax Number	:

Provider Business Practice Location Address
First Line	:	7519 MENTOR AVE STE 211
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-5434
Country	:	US
Telephone Number	:	440-701-6170
Fax Number	:

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

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	01/29/2020

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Directions to “ SARA R CICCHINELLI LPCC” Practice Location

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