Provider Demographics
NPI:1912152422
Name:CICCHELLI, DONALD ROBERT JR (MDV)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ROBERT
Last Name:CICCHELLI
Suffix:JR
Gender:M
Credentials:MDV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 LINCOLN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2879
Mailing Address - Country:US
Mailing Address - Phone:305-531-5341
Mailing Address - Fax:305-532-5322
Practice Address - Street 1:701 LINCOLN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2879
Practice Address - Country:US
Practice Address - Phone:305-531-5341
Practice Address - Fax:305-532-5322
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health