Provider Demographics
NPI:1336233923
Name:CIOCCA, MARK JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:CIOCCA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8 CENTRE STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6302
Mailing Address - Country:US
Mailing Address - Phone:603-228-7300
Mailing Address - Fax:603-228-7301
Practice Address - Street 1:8 CENTRE STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-6302
Practice Address - Country:US
Practice Address - Phone:603-228-7300
Practice Address - Fax:603-228-7301
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH395103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1052491OtherCIGNA BEHAVIORAL CARE
NH0607830Y0NH01OtherANTHEM
NH279537OtherVALUE OPTIONS
NH104588OtherMAGELLAN
NH30011502Medicaid
NH30011502Medicaid