Provider Demographics
NPI:1730938622
Name:CICCHINO, ANGELA (BA, NCPRSS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CICCHINO
Suffix:
Gender:F
Credentials:BA, NCPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 HIGHWAY 35 BLDG A3
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4254
Mailing Address - Country:US
Mailing Address - Phone:732-837-9400
Mailing Address - Fax:
Practice Address - Street 1:99 HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6423
Practice Address - Country:US
Practice Address - Phone:732-557-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P00586101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)