Provider Demographics
NPI:1376150078
Name:CICIA, ALYSSA ROSE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ROSE
Last Name:CICIA
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 1:140 ATLANTIC AVE UNIT 424
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2040
Mailing Address - Country:US
Mailing Address - Phone:516-754-2406
Mailing Address - Fax:
Practice Address - Street 1:450 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2852
Practice Address - Country:US
Practice Address - Phone:516-390-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist