Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 022417-1 | NY |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 022417-1 | NY |
NPI | 1083255673 |
---|---|
Provider Name | Dr. Courtney Veronica Ciccone |
First Address | Katonah, NY 10536-2146 |
Second Address | Katonah, NY 10536-2146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2019 |
Last Update Date | 04/10/2019 |