Provider Demographics
NPI:1699114934
Name:CARLUCCI, JUSTINE (LMFT)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:CARLUCCI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RIVERSIDE DR STE 270
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-4947
Mailing Address - Country:US
Mailing Address - Phone:339-235-5116
Mailing Address - Fax:
Practice Address - Street 1:28 RIVERSIDE DR STE 270
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-4947
Practice Address - Country:US
Practice Address - Phone:339-235-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1661106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist