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General NPI Number Information
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NPI Number | 1144038225
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Entity Type | Individual
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Provider Name | LUCIA MK MATTEUCCI
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 600 E OGLETHORPE HWY STE B
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City | HINESVILLE
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State | GA
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Zip | 31313-2988
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Country | US
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Telephone | 407-907-2077
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Fax | 973-888-1377
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Provider Business Mailing Address
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Address Line | 521 MAJESTY DR
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City | DAVENPORT
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State | FL
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Zip | 33837-0504
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Country | US
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Telephone | 863-256-7792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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