Provider Demographics
NPI:1295848737
Name:FIORUCCI, JAMIE LEAH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEAH
Last Name:FIORUCCI
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:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WATERSMEET
Mailing Address - State:MI
Mailing Address - Zip Code:49969-0309
Mailing Address - Country:US
Mailing Address - Phone:906-390-0363
Mailing Address - Fax:906-884-4794
Practice Address - Street 1:652 E CLOVERLAND DR STE 2
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-1422
Practice Address - Country:US
Practice Address - Phone:906-390-0363
Practice Address - Fax:906-884-4794
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011064241041C0700X
MI68020822571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical