Provider Demographics
NPI:1053662734
Name:CUCCI, ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CUCCI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:CUCCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:3145 W PRATT BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4125
Mailing Address - Country:US
Mailing Address - Phone:773-467-3700
Mailing Address - Fax:
Practice Address - Street 1:3145 W PRATT BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4125
Practice Address - Country:US
Practice Address - Phone:773-467-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist