Provider Demographics
NPI:1114582772
Name:FUOCO, MICAELA (LPC)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:FUOCO
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 W PARKSIDE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1232
Mailing Address - Country:US
Mailing Address - Phone:480-757-5885
Mailing Address - Fax:
Practice Address - Street 1:1904 W PARKSIDE LN STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1232
Practice Address - Country:US
Practice Address - Phone:480-757-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18025101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor