Individual
MR. BENJAMIN EVAN FICOCIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2262 HARVARD ST, PALO ALTO, CA 94306-1351
(919) 758-5339
Mailing address
1101 S WINCHESTER BLVD STE B110, SAN JOSE, CA 95128-3914
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-30811
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000023532
BMC
MA
01
—
042611055
TAX ID
MA
01
—
1004745
NHP
MA
01
—
1303287
MBHP
MA
05
—
1303287
—
MA
01
—
99618201
NETWORK HEALTH
MA
01
—
M18633
BCBS
MA
Enumeration date
09/12/2014
Last updated
03/21/2022
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