Provider Demographics
NPI:1699981464
Name:CICERO, BARBARA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANN
Last Name:CICERO
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 1:8535 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4332
Mailing Address - Country:US
Mailing Address - Phone:718-305-8710
Mailing Address - Fax:
Practice Address - Street 1:8535 54TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4332
Practice Address - Country:US
Practice Address - Phone:718-305-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013198103G00000X, 103T00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation