Healthcare Provider Details

I. General information

NPI: 1558511238
Provider Name (Legal Business Name): STEPHEN CIUCCI L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SUMMIT RD SUITE L
PROSPECT CT
06712-1426
US

IV. Provider business mailing address

2 SUMMIT RD SUITE L
PROSPECT CT
06712-1426
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-3522
  • Fax: 203-758-3522
Mailing address:
  • Phone: 203-758-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001625
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: