Provider Demographics
NPI:1356410138
Name:RANUCCI, PAUL (LCPC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:RANUCCI
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2710
Mailing Address - Country:US
Mailing Address - Phone:207-780-0020
Mailing Address - Fax:207-780-0022
Practice Address - Street 1:576 SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2710
Practice Address - Country:US
Practice Address - Phone:207-780-0020
Practice Address - Fax:207-780-0022
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC187101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)