Provider Demographics
NPI:1114410172
Name:CATUCCIO, LORRAINE LUCIO (MS)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:LUCIO
Last Name:CATUCCIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:LUCIO
Other - Last Name:FRAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:57 DEER HILL LN
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1236
Mailing Address - Country:US
Mailing Address - Phone:617-417-3124
Mailing Address - Fax:
Practice Address - Street 1:100 WARREN CIR
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2074
Practice Address - Country:US
Practice Address - Phone:487-860-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist