Provider Demographics
NPI:1689389447
Name:CICALA, MICHELLE R (MSN, APN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:R
Last Name:CICALA
Suffix:
Gender:F
Credentials:MSN, APN, PMHNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CICALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APN, PMHNP-BC
Mailing Address - Street 1:51 GREENDALE RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1312
Mailing Address - Country:US
Mailing Address - Phone:973-865-1912
Mailing Address - Fax:
Practice Address - Street 1:351 EVELYN ST
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2901
Practice Address - Country:US
Practice Address - Phone:201-977-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01424800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty