Provider Demographics
NPI:1023762267
Name:DICICCO, CELINDA T (BT)
Entity type:Individual
Prefix:
First Name:CELINDA
Middle Name:T
Last Name:DICICCO
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 W SMITH ST UNIT 147
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5342
Mailing Address - Country:US
Mailing Address - Phone:407-385-9581
Mailing Address - Fax:
Practice Address - Street 1:12702 SCIENCE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3016
Practice Address - Country:US
Practice Address - Phone:407-574-4629
Practice Address - Fax:407-574-3437
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician