Provider Demographics
NPI:1831402627
Name:CICORIA, MATTHEW J (MS, BCBA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:CICORIA
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SOUTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03255-5307
Mailing Address - Country:US
Mailing Address - Phone:603-568-3646
Mailing Address - Fax:
Practice Address - Street 1:36 SOUTHGATE RD
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:NH
Practice Address - Zip Code:03255-5307
Practice Address - Country:US
Practice Address - Phone:603-568-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst