Provider Demographics
NPI:1407828171
Name:CIANCIOLO, JOSEPH JUDE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JUDE
Last Name:CIANCIOLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E MACTANLY PL
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2316
Mailing Address - Country:US
Mailing Address - Phone:540-886-3063
Mailing Address - Fax:540-886-6246
Practice Address - Street 1:102 MACTANLY PL
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2316
Practice Address - Country:US
Practice Address - Phone:540-886-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA013085OtherBLUE CROSS BLUE SHIELD
VA7701896Medicaid