Provider Demographics
NPI:1427491109
Name:CUCCURULLO, LISA-ANN JUDITH (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA-ANN
Middle Name:JUDITH
Last Name:CUCCURULLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CANAL ST
Mailing Address - Street 2:ROOM 211
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6109
Mailing Address - Country:US
Mailing Address - Phone:504-571-8303
Mailing Address - Fax:
Practice Address - Street 1:3500 CANAL ST
Practice Address - Street 2:ROOM 211
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6109
Practice Address - Country:US
Practice Address - Phone:504-571-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical