Provider Demographics
NPI:1932463700
Name:GALLUCCI, MARIELA (MSED)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:GALLUCCI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MCFARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4158
Mailing Address - Country:US
Mailing Address - Phone:631-682-1177
Mailing Address - Fax:
Practice Address - Street 1:8 MCFARLAND AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4158
Practice Address - Country:US
Practice Address - Phone:631-682-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist