Provider Demographics
NPI:1982428181
Name:CICCHINE, DINA (MA, LCADC)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:CICCHINE
Suffix:
Gender:F
Credentials:MA, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CAYUGA AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1012
Mailing Address - Country:US
Mailing Address - Phone:973-997-0321
Mailing Address - Fax:
Practice Address - Street 1:76 CAYUGA AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-1012
Practice Address - Country:US
Practice Address - Phone:973-997-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00384300101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor