Provider Demographics
NPI:1194294041
Name:CICORA-BROWN, CHELSESA MAUREEN (LSW)
Entity type:Individual
Prefix:
First Name:CHELSESA
Middle Name:MAUREEN
Last Name:CICORA-BROWN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:MAUREEN
Other - Last Name:CICORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:425 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17724-1633
Mailing Address - Country:US
Mailing Address - Phone:570-673-8662
Mailing Address - Fax:
Practice Address - Street 1:425 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-1633
Practice Address - Country:US
Practice Address - Phone:570-673-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098634104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker