Individual
LISA MARIE CICCONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
319 BROADWAY, PORT EWEN, NY 12466-5501
(845) 339-8707
Mailing address
PO BOX 193, ESOPUS, NY 12429-0193
18455943162
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
Primary
095647
NY
Other
Enumeration date
07/30/2017
Last updated
07/30/2017
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