Provider Demographics
NPI:1376025247
Name:CICCARELLI-SOLOMON, MARTA
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:
Last Name:CICCARELLI-SOLOMON
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 1:11 GALLOWS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1179
Mailing Address - Country:US
Mailing Address - Phone:914-384-8397
Mailing Address - Fax:
Practice Address - Street 1:11 GALLOWS HILL RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-1179
Practice Address - Country:US
Practice Address - Phone:914-384-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist