Provider Demographics
NPI:1538852165
Name:CICCARELLI, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:CICCARELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 POPLAR PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-2005
Mailing Address - Country:US
Mailing Address - Phone:914-424-9618
Mailing Address - Fax:
Practice Address - Street 1:14 POPLAR PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-2005
Practice Address - Country:US
Practice Address - Phone:914-424-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist