Provider Demographics
NPI:1568083764
Name:MARTUCCI, PIETRO VINCENZO (LPC)
Entity Type:Individual
Prefix:
First Name:PIETRO
Middle Name:VINCENZO
Last Name:MARTUCCI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7877 BIG RICE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-8068
Mailing Address - Country:US
Mailing Address - Phone:218-290-2366
Mailing Address - Fax:
Practice Address - Street 1:505 S 12TH AVE W STE 1
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2001
Practice Address - Country:US
Practice Address - Phone:218-749-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2024101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health