Provider Demographics
NPI:1093223158
Name:CICCARELLA, CAROLINE (LPC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CICCARELLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 PATRIOT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1279
Mailing Address - Country:US
Mailing Address - Phone:203-267-3159
Mailing Address - Fax:
Practice Address - Street 1:16 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4019
Practice Address - Country:US
Practice Address - Phone:203-792-0341
Practice Address - Fax:203-723-0702
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3363101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional