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General NPI Number Information
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NPI Number | 1609947266
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Entity Type | Individual
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Provider Name | MICHELE IANNUCCI CPS, LCADC, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 14 SMULL AVE
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City | CALDWELL
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State | NJ
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Zip | 07006-5012
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Country | US
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Telephone | 973-216-6815
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Fax |
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Provider Business Mailing Address
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Address Line | 128 HARVEST LN
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City | LINCOLN PARK
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State | NJ
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Zip | 07035-2045
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Country | US
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Telephone | 973-216-6815
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37PC00145200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00116000
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License Number State | NJ
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