Provider Demographics
NPI:1447985296
Name:CICCOLO, BYRA (MSW)
Entity type:Individual
Prefix:
First Name:BYRA
Middle Name:
Last Name:CICCOLO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 OAK KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2400
Mailing Address - Country:US
Mailing Address - Phone:804-608-9704
Mailing Address - Fax:855-700-5573
Practice Address - Street 1:5712 OAK KNOLL RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2400
Practice Address - Country:US
Practice Address - Phone:804-608-9704
Practice Address - Fax:855-700-5573
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical