Provider Demographics
NPI:1659453702
Name:IANNICELLO, ARLINE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:ARLINE
Middle Name:
Last Name:IANNICELLO
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1943 NEWARK GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9169
Mailing Address - Country:US
Mailing Address - Phone:740-587-5252
Mailing Address - Fax:740-587-2571
Practice Address - Street 1:1943 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9169
Practice Address - Country:US
Practice Address - Phone:740-587-5252
Practice Address - Fax:740-587-2571
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1023101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000218033OtherANTHEM BCBS
OH063019000OtherMAGELLAN