Provider Demographics
NPI:1043888431
Name:MARCUCIO, BRIANNA M (AUD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:M
Last Name:MARCUCIO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2363
Mailing Address - Country:US
Mailing Address - Phone:203-234-1324
Mailing Address - Fax:855-496-0993
Practice Address - Street 1:954 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-7727
Practice Address - Country:US
Practice Address - Phone:203-481-0003
Practice Address - Fax:855-357-1519
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT284231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT284OtherSTATE LICENSE