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NPI Code Detail

MEDICARE: MR. STEPHEN GRANT DETUCCI LMHC, LADC

MEDICARE: MR. STEPHEN GRANT DETUCCI LMHC, LADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1327MA
2101YM0800XMental Health Counselor4839MA

General Provider Information

NPI Number : 1720008832
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN GRANT DETUCCI LMHC, LADC
Provider Business Mailing Address
First Line : 76 LEICESTER RD
Second Line :
City : BELMONT
State : MA
Zip : 02478-3338
Country : US
Telephone Number : 617-489-4665
Fax Number :
Provider Business Practice Location Address
First Line : 22 MILL ST STE 407
Second Line :
City : ARLINGTON
State : MA
Zip : 02476-4744
Country : US
Telephone Number : 781-483-3308
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 09/11/2025

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