Provider Demographics
NPI:1336468032
Name:CIANCIO, GUY ANTHONY (LMHC)
Entity Type:Individual
Prefix:MR
First Name:GUY
Middle Name:ANTHONY
Last Name:CIANCIO
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CANYON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BROAD BROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06016-9691
Mailing Address - Country:US
Mailing Address - Phone:860-758-7861
Mailing Address - Fax:
Practice Address - Street 1:206 CANYON RIDGE DR
Practice Address - Street 2:
Practice Address - City:BROAD BROOK
Practice Address - State:CT
Practice Address - Zip Code:06016-9691
Practice Address - Country:US
Practice Address - Phone:860-758-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health