Provider Demographics
NPI:1013778455
Name:CICERO, SARAH (MA, CRAADC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CICERO
Suffix:
Gender:F
Credentials:MA, CRAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 S BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3715
Mailing Address - Country:US
Mailing Address - Phone:816-405-5988
Mailing Address - Fax:
Practice Address - Street 1:3606 S BRENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3715
Practice Address - Country:US
Practice Address - Phone:816-405-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10519101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)