Provider Demographics
NPI:1760849434
Name:THE CICETTI CENTER FOR NEURORECOVERY INC
Entity Type:Organization
Organization Name:THE CICETTI CENTER FOR NEURORECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-508-7190
Mailing Address - Street 1:1111 HYPOLUXO RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462
Mailing Address - Country:US
Mailing Address - Phone:561-508-7190
Mailing Address - Fax:
Practice Address - Street 1:1111 HYPOLUXO RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-508-7190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X, 103G00000X, 103T00000X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty