Provider Demographics
NPI:1114805942
Name:FUCCI, CARISSA (LPC)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:FUCCI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9072 LOJEK RD
Mailing Address - Street 2:
Mailing Address - City:GUYS MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16327-4124
Mailing Address - Country:US
Mailing Address - Phone:814-795-9351
Mailing Address - Fax:814-746-3994
Practice Address - Street 1:262 CHESTNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3302
Practice Address - Country:US
Practice Address - Phone:814-332-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC019110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional