Provider Demographics
NPI:1013212059
Name:MUCCITELLI, FILOMENA G (LMHC, MA)
Entity Type:Individual
Prefix:MS
First Name:FILOMENA
Middle Name:G
Last Name:MUCCITELLI
Suffix:
Gender:F
Credentials:LMHC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65485
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-5485
Mailing Address - Country:US
Mailing Address - Phone:802-233-9319
Mailing Address - Fax:
Practice Address - Street 1:9677 EAGLE RANCH RD NW APT 2522
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-2133
Practice Address - Country:US
Practice Address - Phone:802-233-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0136261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health