| Theresa L Cicchetto | |
|
1300 Oliver Rd Ste 193 Fairfield CA 94534-3431 | |
| (707) 514-5812 | |
| (707) 673-5549 |
| Full Name | Theresa L Cicchetto |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1300 Oliver Rd Ste 193, Fairfield, California |
| Authorized Official Name and Position | Theresa Louise Cicchetto (OWNER) |
| Authorized Official Contact | 7075145812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Theresa L Cicchetto 1300 Oliver Rd Ste 193 Fairfield CA 94534-3431 Ph: (707) 514-5812 | Theresa L Cicchetto 1300 Oliver Rd Ste 193 Fairfield CA 94534-3431 Ph: (707) 514-5812 |
| NPI Number | 1972969715 |
|---|---|
| Provider Enumeration Date | 01/09/2016 |
| Last Update Date | 12/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972969715 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPCC 1490 (California) | Secondary |
| 106H00000X | Marriage & Family Therapist | MFC 43693 (California) | Primary |
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