1194294041 NPI number — CHELSESA MAUREEN CICORA-BROWN LSW

Table of content: CHELSESA MAUREEN CICORA-BROWN LSW (NPI 1194294041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194294041 NPI number — CHELSESA MAUREEN CICORA-BROWN LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CICORA-BROWN
Provider First Name:
CHELSESA
Provider Middle Name:
MAUREEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CICORA
Provider Other First Name:
CHELSEA
Provider Other Middle Name:
MAUREEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194294041
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17724-1633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-673-8662
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17724-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-673-8662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  098634 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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