Healthcare Provider Details

I. General information

NPI: 1942781612
Provider Name (Legal Business Name): PAMELA E LUCCI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HERRICK ST
BEVERLY MA
01915-1777
US

IV. Provider business mailing address

21 HILLIS AVE
WAKEFIELD MA
01880-3909
US

V. Phone/Fax

Practice location:
  • Phone: 978-816-2954
  • Fax: 978-524-7917
Mailing address:
  • Phone: 781-789-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1029009
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: