Provider Demographics
NPI:1720231152
Name:CICARELLI, MARY ANNE (MS,PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANNE
Middle Name:
Last Name:CICARELLI
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 COBB CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2947
Mailing Address - Country:US
Mailing Address - Phone:631-425-4921
Mailing Address - Fax:
Practice Address - Street 1:8 COBB CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2947
Practice Address - Country:US
Practice Address - Phone:631-425-4921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024708-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist