Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3845 | NJ |
Y | 103TC0700X | Clinical Psychologist | 3845 | NJ |
NPI | 1992929491 |
---|---|
Provider Name | Dr. Rosemarie Ciccarello |
First Address | Montclair, NJ 07042-2677 |
Second Address | Montclair, NJ 07042-2677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
753174764 | FEDERAL TAX ID (01) |