Provider Demographics
NPI:1396765178
Name:DECICCO, DENNIS (PHD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:DECICCO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1630
Mailing Address - Country:US
Mailing Address - Phone:201-327-7755
Mailing Address - Fax:201-461-0089
Practice Address - Street 1:205 N FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1630
Practice Address - Country:US
Practice Address - Phone:201-327-7755
Practice Address - Fax:201-461-0089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100323300103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling