Provider Demographics
NPI:1679771463
Name:CIANCIULLI, JAMES MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:CIANCIULLI
Suffix:
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 1:1920 W MARSHALL ST
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3171
Mailing Address - Country:US
Mailing Address - Phone:215-666-1485
Mailing Address - Fax:610-630-0913
Practice Address - Street 1:1920 W MARSHALL ST
Practice Address - Street 2:SUITE 2-D
Practice Address - City:JEFFERSONVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-3171
Practice Address - Country:US
Practice Address - Phone:215-666-1485
Practice Address - Fax:610-630-0913
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004626101YM0800X
PACSP67-07610046103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health