Provider Demographics
NPI:1902234149
Name:COLUCCI, AMEDEO (LMHC)
Entity Type:Individual
Prefix:MR
First Name:AMEDEO
Middle Name:
Last Name:COLUCCI
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7645 SUN ISLAND DR S
Mailing Address - Street 2:#208
Mailing Address - City:S PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4486
Mailing Address - Country:US
Mailing Address - Phone:954-778-2101
Mailing Address - Fax:727-823-0544
Practice Address - Street 1:928 22ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-2934
Practice Address - Country:US
Practice Address - Phone:727-327-7656
Practice Address - Fax:727-823-0544
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health