Provider Demographics
NPI:1952073132
Name:FUCCI, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20501 VENTURA BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6258
Mailing Address - Country:US
Mailing Address - Phone:818-657-0411
Mailing Address - Fax:
Practice Address - Street 1:20501 VENTURA BLVD STE 170
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-6258
Practice Address - Country:US
Practice Address - Phone:818-657-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1122341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR1437140721OtherTARZANA TREATMENT CENTER