Individual
LORI LYNN CICCONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
350 GOOSE LN STE 203B, GUILFORD, CT 06437-2492
(203) 932-6481
(039) 324-0512
Mailing address
322 E MAIN ST STE 1B, BRANFORD, CT 06405-3136
(034) 887-2282
(203) 204-1415
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001888
CT
363AM0700X
Medical Physician Assistant
Primary
001888
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001888
LIC
CT
Enumeration date
03/01/2007
Last updated
12/08/2023
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