Provider Demographics
NPI:1790724623
Name:LUCCI, JOSETTE M (LMSW)
Entity Type:Individual
Prefix:
First Name:JOSETTE
Middle Name:M
Last Name:LUCCI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JOSETTE
Other - Middle Name:MAE
Other - Last Name:POUPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 JOHN R RD STE 113
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4317
Mailing Address - Country:US
Mailing Address - Phone:248-765-4550
Mailing Address - Fax:248-750-0807
Practice Address - Street 1:1000 JOHN R RD STE 113
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4317
Practice Address - Country:US
Practice Address - Phone:248-765-4550
Practice Address - Fax:248-750-0807
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801067006104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26426204Medicare ID - Type Unspecified
MIP45900Medicare UPIN