MEDICARE: JUSTINE CARLUCCI LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1661	MA

General Provider Information

NPI Number	:	1699114934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE CARLUCCI LMFT

Provider Business Mailing Address
First Line	:	28 RIVERSIDE DR STE 270
Second Line	:
City	:	PEMBROKE
State	:	MA
Zip	:	02359-4947
Country	:	US
Telephone Number	:	339-235-5116
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 RIVERSIDE DR STE 270
Second Line	:
City	:	PEMBROKE
State	:	MA
Zip	:	02359-4947
Country	:	US
Telephone Number	:	339-235-5116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	01/25/2022

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