Provider Demographics
NPI:1487069886
Name:DEMUCCI, JUDITH (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:DEMUCCI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2007
Mailing Address - Country:US
Mailing Address - Phone:207-899-9519
Mailing Address - Fax:201-939-3132
Practice Address - Street 1:23 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5740
Practice Address - Country:US
Practice Address - Phone:207-899-9519
Practice Address - Fax:201-939-3132
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2020-08-07
Deactivation Date:2019-07-01
Deactivation Code:
Reactivation Date:2020-08-07
Provider Licenses
StateLicense IDTaxonomies
MELC79551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical