MEDICARE: DR. MARLA J VANNUCCI PH.D.

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
1	103TC0700X	Clinical Psychologist	071006033	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1633497	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1972547768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLA J VANNUCCI PH.D.

Provider Business Mailing Address
First Line	:	5551 HIGH TOR HL
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2465
Country	:	US
Telephone Number	:	773-412-0872
Fax Number	:	312-281-2901

Provider Business Practice Location Address
First Line	:	2835 N SHEFFIELD AVE STE 410
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5084
Country	:	US
Telephone Number	:	312-281-2901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	02/12/2026

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