Provider Demographics
NPI:1972834661
Name:MUCCI, POLLY
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:MUCCI
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 1:44174 W CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-5411
Mailing Address - Country:US
Mailing Address - Phone:330-309-2826
Mailing Address - Fax:
Practice Address - Street 1:44174 W CANYON CREEK DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-5411
Practice Address - Country:US
Practice Address - Phone:330-309-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2100892385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child