Provider Demographics
NPI:1821195249
Name:CICALONI, MARA E (MS, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:E
Last Name:CICALONI
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05143-0844
Mailing Address - Country:US
Mailing Address - Phone:802-875-5335
Mailing Address - Fax:802-875-5337
Practice Address - Street 1:287 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VT
Practice Address - Zip Code:05143
Practice Address - Country:US
Practice Address - Phone:802-875-5335
Practice Address - Fax:802-875-5337
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010770Medicaid
VT58671100OtherMAGELLAN
VT2031051OtherCIGNA BH
VT787462OtherMVP
VT00068213OtherBCBS