Provider Demographics
NPI:1063553923
Name:CICCARELLI, SHAFIYA (MSW, CAGS)
Entity type:Individual
Prefix:
First Name:SHAFIYA
Middle Name:
Last Name:CICCARELLI
Suffix:
Gender:F
Credentials:MSW, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01360-0964
Mailing Address - Country:US
Mailing Address - Phone:413-498-2787
Mailing Address - Fax:
Practice Address - Street 1:ALEXANDER HILL ROAD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MA
Practice Address - Zip Code:01360-0964
Practice Address - Country:US
Practice Address - Phone:413-498-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1064031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical