Provider Demographics
NPI:1255911483
Name:CICAK, CHRISTIN LEIGH
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:LEIGH
Last Name:CICAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WALNUT ST FL 1
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-2801
Mailing Address - Country:US
Mailing Address - Phone:141-253-5175
Mailing Address - Fax:
Practice Address - Street 1:500 WALNUT ST FL 1
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2801
Practice Address - Country:US
Practice Address - Phone:141-253-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator