Provider Demographics
NPI:1831678267
Name:CIANCIARULO, MIA
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:CIANCIARULO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2948
Mailing Address - Country:US
Mailing Address - Phone:781-974-7483
Mailing Address - Fax:
Practice Address - Street 1:200 IVY ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3907
Practice Address - Country:US
Practice Address - Phone:617-732-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker