Provider Demographics
NPI:1851176705
Name:CICCHINI, CARLO WINSTON
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:WINSTON
Last Name:CICCHINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CARLO
Other - Middle Name:WINSTON
Other - Last Name:GUAYAMARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30205 SW 154TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3506
Mailing Address - Country:US
Mailing Address - Phone:619-389-5579
Mailing Address - Fax:
Practice Address - Street 1:30205 SW 154TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3506
Practice Address - Country:US
Practice Address - Phone:619-389-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-286228106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician