Provider Demographics
NPI:1639395395
Name:CICCHIELLO, JOAN M (PHD, PMHNP, B-C)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:M
Last Name:CICCHIELLO
Suffix:
Gender:F
Credentials:PHD, PMHNP, B-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-1303
Mailing Address - Country:US
Mailing Address - Phone:570-875-8058
Mailing Address - Fax:570-554-4357
Practice Address - Street 1:601 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-1803
Practice Address - Country:US
Practice Address - Phone:570-875-8058
Practice Address - Fax:570-554-4357
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006931C363LA2200X
PASP009838363LP0808X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology