Provider Demographics
NPI:1043047152
Name:CIACCI, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:CIACCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MURDOCK ST
Mailing Address - Street 2:
Mailing Address - City:MINGO JUNCTION
Mailing Address - State:OH
Mailing Address - Zip Code:43938-1062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 MURDOCK ST
Practice Address - Street 2:
Practice Address - City:MINGO JUNCTION
Practice Address - State:OH
Practice Address - Zip Code:43938-1062
Practice Address - Country:US
Practice Address - Phone:740-314-8195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.005347171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator