Provider Demographics
NPI:1699385146
Name:LUCCI, RENEE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:LUCCI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:LUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:228 PARK AVE S
Mailing Address - Street 2:SUITE 15314
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4941
Mailing Address - Country:US
Mailing Address - Phone:215-585-2144
Mailing Address - Fax:267-780-7032
Practice Address - Street 1:161 CECIL B MOORE
Practice Address - Street 2:SUITE 204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3243
Practice Address - Country:US
Practice Address - Phone:215-585-2144
Practice Address - Fax:267-780-7032
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022319363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health