Provider Demographics
NPI:1164449021
Name:CICCONE, MARSHA K (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:K
Last Name:CICCONE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 N OCEAN BLVD
Mailing Address - Street 2:APT. 14D
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-3747
Mailing Address - Country:US
Mailing Address - Phone:954-383-3619
Mailing Address - Fax:954-563-9530
Practice Address - Street 1:1915 NE 45TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5199
Practice Address - Country:US
Practice Address - Phone:954-383-3619
Practice Address - Fax:954-563-9530
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW70331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2825Medicare ID - Type Unspecified