Provider Demographics
NPI:1396395422
Name:LUCCHESI, KRISTI ANTIONETTE
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:ANTIONETTE
Last Name:LUCCHESI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 ANNADALE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4034
Mailing Address - Country:US
Mailing Address - Phone:718-702-8951
Mailing Address - Fax:
Practice Address - Street 1:962 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7041
Practice Address - Country:US
Practice Address - Phone:718-982-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health