Provider Demographics
NPI:1801281126
Name:MARCUCCIO, ASHLEY
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:MARCUCCIO
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 1:2222 S 16TH ST STE 400A
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3785
Mailing Address - Country:US
Mailing Address - Phone:402-483-8590
Mailing Address - Fax:
Practice Address - Street 1:2221 S 17TH ST STE 202
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3763
Practice Address - Country:US
Practice Address - Phone:402-483-8555
Practice Address - Fax:402-483-8554
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE21342084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program