Provider Demographics
NPI:1265793533
Name:DECICCO, LINDSAY NICOLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:NICOLE
Last Name:DECICCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LINDSAY
Other - Middle Name:NICOLE
Other - Last Name:ANNARELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1930 ROUTE 70 E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-751-0505
Mailing Address - Fax:
Practice Address - Street 1:1930 ROUTE 70 E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-751-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05765200104100000X
NJ44SC057079001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker