1720127293 NPI number — STEPHANIE ROTH LUCCHESI M.S. COUNSELING, MFT

Table of content: STEPHANIE ROTH LUCCHESI M.S. COUNSELING, MFT (NPI 1720127293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720127293 NPI number — STEPHANIE ROTH LUCCHESI M.S. COUNSELING, MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCCHESI
Provider First Name:
STEPHANIE
Provider Middle Name:
ROTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. COUNSELING, MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROTH
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. COUNSELING, MFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720127293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4232 BROOKHILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95628-6923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-207-1067
Provider Business Mailing Address Fax Number:
916-967-7304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3125 DWIGHT RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-691-2200
Provider Business Practice Location Address Fax Number:
916-967-7304
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YS0200X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: MFC 30942 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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