Provider Demographics
NPI:1629301411
Name:NUCCILLI, ALICIA D (CTRS)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:D
Last Name:NUCCILLI
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22291 LEEWRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3901
Mailing Address - Country:US
Mailing Address - Phone:248-487-0681
Mailing Address - Fax:
Practice Address - Street 1:22291 LEEWRIGHT AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3901
Practice Address - Country:US
Practice Address - Phone:248-487-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health