Provider Demographics
NPI:1609947266
Name:IANNUCCI, MICHELE (CPS, LCADC, LPC)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:IANNUCCI
Suffix:
Gender:F
Credentials:CPS, LCADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-2045
Mailing Address - Country:US
Mailing Address - Phone:973-216-6815
Mailing Address - Fax:
Practice Address - Street 1:14 SMULL AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5012
Practice Address - Country:US
Practice Address - Phone:973-216-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00145200101Y00000X
NJ37LC00116000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)