Provider Demographics
NPI:1023901659
Name:PETRUCCI, AMELIA PATRICIA (LMSW-CC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:PATRICIA
Last Name:PETRUCCI
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOWARD ST APT A
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1973
Mailing Address - Country:US
Mailing Address - Phone:401-932-4254
Mailing Address - Fax:
Practice Address - Street 1:15 YORK ST STE 201A
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-5532
Practice Address - Country:US
Practice Address - Phone:207-893-0386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC247861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical