Provider Demographics
NPI:1902978174
Name:CARLUCCIO, SHEILA C (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:C
Last Name:CARLUCCIO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:SHEILA
Other - Middle Name:LAURA
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:123 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519
Mailing Address - Country:US
Mailing Address - Phone:570-383-6404
Mailing Address - Fax:570-489-0004
Practice Address - Street 1:123 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519
Practice Address - Country:US
Practice Address - Phone:570-383-6404
Practice Address - Fax:570-489-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007080L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01462046Medicaid
PACA519030OtherBLUE SHIELD
PA078903OtherFIRST PRIORITY HEALTH