Provider Demographics
NPI:1386355907
Name:CICCARONE, PAULA (PHD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:CICCARONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LAKE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1135
Mailing Address - Country:US
Mailing Address - Phone:773-665-8052
Mailing Address - Fax:708-384-7501
Practice Address - Street 1:1010 LAKE ST STE 500
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1135
Practice Address - Country:US
Practice Address - Phone:773-665-8052
Practice Address - Fax:708-384-7501
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007088103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical