MEDICARE: MRS. STEPHANIE NICOSIA PUCHNER B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1780825828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE NICOSIA PUCHNER B.S.

Provider Business Mailing Address
First Line	:	PO BOX 177
Second Line	:
City	:	VALATIE
State	:	NY
Zip	:	12184-0177
Country	:	US
Telephone Number	:	518-929-1799
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 CENTRAL AVE # 2
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1514
Country	:	US
Telephone Number	:	518-369-8705
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/19/2009

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