Provider Demographics
NPI:1992241814
Name:AMICONE, JUDITH ANNE (LPC, LICDC-CS)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANNE
Last Name:AMICONE
Suffix:
Gender:F
Credentials:LPC, LICDC-CS
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:ANNE
Other - Last Name:SPARANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LICDC-CS
Mailing Address - Street 1:1135 SPARROW RUN
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4352
Mailing Address - Country:US
Mailing Address - Phone:216-406-7678
Mailing Address - Fax:
Practice Address - Street 1:4500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3736
Practice Address - Country:US
Practice Address - Phone:216-413-3205
Practice Address - Fax:216-432-7259
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902282101YP2500X
OHLICDC.161357101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional