Provider Demographics
NPI:1427335215
Name:CICILLINE, NANETTE FABIENNE (MFT)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:FABIENNE
Last Name:CICILLINE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2034
Mailing Address - Country:US
Mailing Address - Phone:401-270-6156
Mailing Address - Fax:401-270-2316
Practice Address - Street 1:71 GRACE ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2034
Practice Address - Country:US
Practice Address - Phone:401-270-6156
Practice Address - Fax:401-270-2316
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist