Provider Demographics
NPI:1720008832
Name:DETUCCI, STEPHEN GRANT (LMHC, LADC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GRANT
Last Name:DETUCCI
Suffix:
Gender:M
Credentials:LMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 LEICESTER RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3338
Mailing Address - Country:US
Mailing Address - Phone:617-489-4665
Mailing Address - Fax:
Practice Address - Street 1:22 MILL ST STE 407
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4744
Practice Address - Country:US
Practice Address - Phone:781-483-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1327101YA0400X
MA4839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health