Provider Demographics
NPI:1548640261
Name:CHICCUARELLI, CAILYN
Entity type:Individual
Prefix:
First Name:CAILYN
Middle Name:
Last Name:CHICCUARELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WESMUR RD
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4731
Mailing Address - Country:US
Mailing Address - Phone:617-909-3484
Mailing Address - Fax:
Practice Address - Street 1:22 PLEASANT ST
Practice Address - Street 2:DOWLING BUILDING CO
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5119
Practice Address - Country:US
Practice Address - Phone:781-851-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health