=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922927896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JESSICA CARLUCCI LCSW P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2026
-----------------------------------------------------
Last Update Date | 07/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 N COUNTRY RD
-----------------------------------------------------
City | EAST SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11733-1354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-241-8051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 N COUNTRY RD STE 4
-----------------------------------------------------
City | EAST SETAUKET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11733-1354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JESSICA KIM CARLUCCI
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 631-241-8051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------