Provider Demographics
NPI:1457446429
Name:CICHOCKI SIEGWARTH, CARRIE R (CNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:R
Last Name:CICHOCKI SIEGWARTH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:R
Other - Last Name:CICHOCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 74953
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-1036
Mailing Address - Country:US
Mailing Address - Phone:216-671-0408
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # P57
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-5612
Practice Address - Country:US
Practice Address - Phone:216-444-0102
Practice Address - Fax:216-636-1863
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN290702/PNS00030363LP0808X
RIRN40515/NPP37250363LP0808X
MARN25645363LP0808X
OHNS-10529364SP0809X
OHNP-10530363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6289177OtherUNITED BEHAVIORAL HEALTH
P81938Medicare UPIN
RI007057243Medicare ID - Type Unspecified