Provider Demographics
NPI:1366572539
Name:CHIRICHIELLO, AMEDEO (LPC)
Entity type:Individual
Prefix:MR
First Name:AMEDEO
Middle Name:
Last Name:CHIRICHIELLO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WASHBURN PL
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5615
Mailing Address - Country:US
Mailing Address - Phone:973-226-6029
Mailing Address - Fax:973-226-6029
Practice Address - Street 1:1149 BLOOMFIELD AVE
Practice Address - Street 2:CREATIVE INTERVENTION
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2314
Practice Address - Country:US
Practice Address - Phone:973-365-2300
Practice Address - Fax:973-365-0868
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC01719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health