Provider Demographics
NPI:1255015723
Name:CICERO, STEPHANIE (LMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:CICERO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 S CLINTON AVE STE 448
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5719
Mailing Address - Country:US
Mailing Address - Phone:585-301-2478
Mailing Address - Fax:
Practice Address - Street 1:1815 S CLINTON AVE STE 448
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5719
Practice Address - Country:US
Practice Address - Phone:585-301-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health