# FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407237696
- **Authorized official:** JOAN M CICCHIELLO NP (EXECUTIVE)
- **Authorized official phone:** (570) 875-9434

## Contact information

- **Practice address:** 601 W 5TH ST, MOUNT CARMEL, PA 17851-1803
- **Practice address phone:** (570) 875-9434
- **Mailing address:** 601 W 5TH ST, MOUNT CARMEL, PA 17851-1803
- **Mailing address phone:** (570) 875-9434

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |
| 364SA2200X | Adult Health Clinical Nurse Specialist | TP006931C | PA | — |
| 364SP0809X | Adult Psychiatric/Mental Health Clinical Nurse Specialist | SP009839 | PA | — |
| 364SP0809X | Adult Psychiatric/Mental Health Clinical Nurse Specialist | — | NULL | — |
| 364SP0809X | Adult Psychiatric/Mental Health Clinical Nurse Specialist | — | — | — |

## Other

- **Enumeration date:** 06/12/2015
- **Last updated:** 08/20/2015