Provider Demographics
NPI:1003623638
Name:CICCI, JENNIFER (MED LBS LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CICCI
Suffix:
Gender:F
Credentials:MED LBS LSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3319 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3319 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:PA
Practice Address - Zip Code:15227-2722
Practice Address - Country:US
Practice Address - Phone:412-882-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker