Provider Demographics
NPI:1003131210
Name:CICATELLO, TONI
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:CICATELLO
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 1:18321 VENTURA BLVD
Mailing Address - Street 2:SUITE 515
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18321 VENTURA BLVD
Practice Address - Street 2:SUITE 515
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4228
Practice Address - Country:US
Practice Address - Phone:818-757-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22343106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist