Provider Demographics
NPI:1992394027
Name:MARUCCO, KERRI ANNE
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ANNE
Last Name:MARUCCO
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 1:20B E ROSEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3868
Mailing Address - Country:US
Mailing Address - Phone:717-560-2372
Mailing Address - Fax:717-560-2027
Practice Address - Street 1:20B E ROSEVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3868
Practice Address - Country:US
Practice Address - Phone:717-560-2372
Practice Address - Fax:717-560-2027
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PABH003261103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health