Provider Demographics
NPI:1609446152
Name:LUCIBELLO, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LUCIBELLO
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 1:25 TENAKILL RD
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-1430
Mailing Address - Country:US
Mailing Address - Phone:201-803-8567
Mailing Address - Fax:
Practice Address - Street 1:25 TENAKILL RD
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-1430
Practice Address - Country:US
Practice Address - Phone:201-803-8567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00859700101YM0800X, 101YP2500X
NY012136101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional