Provider Demographics
NPI:1730103573
Name:MARTUCCI, TERI L (LMT, MSW)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:L
Last Name:MARTUCCI
Suffix:
Gender:F
Credentials:LMT, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 NW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1121
Mailing Address - Country:US
Mailing Address - Phone:352-337-2884
Mailing Address - Fax:352-337-2884
Practice Address - Street 1:4735 NW 30TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1121
Practice Address - Country:US
Practice Address - Phone:352-337-2884
Practice Address - Fax:352-337-2884
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 17019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist