Provider Demographics
NPI:1033712930
Name:PETRUCCI, ADRIANA (LMSW)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:PETRUCCI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 NOTTAWASSIPEE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9289
Mailing Address - Country:US
Mailing Address - Phone:248-880-9008
Mailing Address - Fax:
Practice Address - Street 1:1308 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2253
Practice Address - Country:US
Practice Address - Phone:734-451-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011058361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical