Provider Demographics
NPI:1447623442
Name:MARCUCCI, EMIL
Entity type:Individual
Prefix:
First Name:EMIL
Middle Name:
Last Name:MARCUCCI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-2538
Mailing Address - Country:US
Mailing Address - Phone:847-613-7159
Mailing Address - Fax:
Practice Address - Street 1:587 SOUTH DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-2538
Practice Address - Country:US
Practice Address - Phone:847-613-7159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker