Provider Demographics
NPI:1336581479
Name:CICERO, CHRISTINA M (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:CICERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2516
Mailing Address - Country:US
Mailing Address - Phone:860-803-7982
Mailing Address - Fax:
Practice Address - Street 1:27 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2516
Practice Address - Country:US
Practice Address - Phone:860-803-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0108531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT85-0568215OtherPRIVATE PAY OR INSURANCE