Provider Demographics
NPI:1922650894
Name:TUCCI, CAMILLE MARIE (LLP)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:MARIE
Last Name:TUCCI
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3903
Mailing Address - Country:US
Mailing Address - Phone:248-398-4193
Mailing Address - Fax:
Practice Address - Street 1:618 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1962
Practice Address - Country:US
Practice Address - Phone:248-629-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009116103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist