Provider Demographics
NPI:1801827654
Name:LUCCHESI, MICHELLE RAE (MA, LLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RAE
Last Name:LUCCHESI
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 E WARWICK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1085
Mailing Address - Country:US
Mailing Address - Phone:989-463-2779
Mailing Address - Fax:989-463-2064
Practice Address - Street 1:317 E WARWICK DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1085
Practice Address - Country:US
Practice Address - Phone:989-463-2779
Practice Address - Fax:989-463-2064
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009560103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist