Provider Demographics
NPI:1215317854
Name:CICCARELLO, CYNTHIA (LMHC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CICCARELLO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 70TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2009
Mailing Address - Country:US
Mailing Address - Phone:253-213-3733
Mailing Address - Fax:
Practice Address - Street 1:8524 STEILACOOM BLVD SW
Practice Address - Street 2:SUITE 102B #2
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4772
Practice Address - Country:US
Practice Address - Phone:253-237-3348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60515854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health