Provider Demographics
NPI:1275978074
Name:CIANCIOSO, NICHOLAS DEAN (MA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DEAN
Last Name:CIANCIOSO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 NW 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4803
Mailing Address - Country:US
Mailing Address - Phone:954-376-2505
Mailing Address - Fax:
Practice Address - Street 1:6530 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4301
Practice Address - Country:US
Practice Address - Phone:954-744-3696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health