Provider Demographics
NPI:1770369407
Name:CIACCI, CHIARA (MFT)
Entity type:Individual
Prefix:
First Name:CHIARA
Middle Name:
Last Name:CIACCI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WALTER CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3602
Mailing Address - Country:US
Mailing Address - Phone:310-733-9588
Mailing Address - Fax:
Practice Address - Street 1:2716 S VERMONT AVE STE 9
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2594
Practice Address - Country:US
Practice Address - Phone:323-810-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist