Doctor Name: | KIMBERLY MICUCCI |
NPI Number: | 1154613909 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCDP |
License Number: | CDP00497 |
Business Practice Address: | 1950 Tower Hill Road Acute Stabilization Unit North Kingstown, RI - 02852 |
Business Phone Number: | 4012357000 |
Business Fax Number: | |
Mailing Address: | 1950 Tower Hill Road, Acute Stabilization Unit NORTH KINGSTOWN |
State: | RI |
Postal Code: | 02852 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/12/2011 |
NPI Last Update Date: | 05/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CDP00497 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |