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NPI Code Detail

MEDICARE: MARYELLEN CARLUCCI

MEDICARE: MARYELLEN CARLUCCI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerF405890-01NY

General Provider Information

NPI Number : 1528915907
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYELLEN CARLUCCI
Provider Business Mailing Address
First Line : 6386 TRANSIT RD APT 348
Second Line :
City : DEPEW
State : NY
Zip : 14043-1125
Country : US
Telephone Number : 716-294-3995
Fax Number : 833-974-2031
Provider Business Practice Location Address
First Line : 107 INSTITUTE ST
Second Line :
City : JAMESTOWN
State : NY
Zip : 14701-6628
Country : US
Telephone Number : 716-294-3995
Fax Number : 833-974-2031
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2026
Last Update Date : 03/13/2026

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Directions to “ MARYELLEN CARLUCCI ” Practice Location

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