Provider Demographics
NPI:1407902455
Name:CIPRIANO, MICHELE A (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:CIPRIANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8917
Mailing Address - Country:US
Mailing Address - Phone:516-297-0704
Mailing Address - Fax:
Practice Address - Street 1:538 RTE 25A
Practice Address - Street 2:SUITE5
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9089
Practice Address - Country:US
Practice Address - Phone:516-297-0704
Practice Address - Fax:631-849-4522
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0539741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNC1982Medicare PIN