Provider Demographics
NPI:1558012369
Name:LUCY, REBECCA PELLERITO (LMHC)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:PELLERITO
Last Name:LUCY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 808 BOX 2182
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09618-0022
Mailing Address - Country:US
Mailing Address - Phone:315-221-8595
Mailing Address - Fax:
Practice Address - Street 1:23401 S COLONIAL CT
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2629
Practice Address - Country:US
Practice Address - Phone:315-221-8595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000343A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health