Provider Demographics
NPI:1629215181
Name:GALLUCCI, ADRIANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:
Last Name:GALLUCCI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ADRIANNE
Other - Middle Name:M
Other - Last Name:GALLUCCI-BREITHAUPT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9502 N 47TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-5219
Mailing Address - Country:US
Mailing Address - Phone:602-515-7811
Mailing Address - Fax:
Practice Address - Street 1:1825 E NORTHERN AVE STE 161B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3812
Practice Address - Country:US
Practice Address - Phone:480-865-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3688103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical