Provider Demographics
NPI:1417164856
Name:CIECKO, WALTER J JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:CIECKO
Suffix:JR
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 1:1301 N HARRISON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3163
Mailing Address - Country:US
Mailing Address - Phone:302-429-0195
Mailing Address - Fax:302-777-1712
Practice Address - Street 1:1301 N HARRISON ST STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3163
Practice Address - Country:US
Practice Address - Phone:302-429-0195
Practice Address - Fax:302-777-1712
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB10000167103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist