Healthcare Provider Details

I. General information

NPI: 1023973880
Provider Name (Legal Business Name): NANCY JEAN PICUNKO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 HIDDEN RIDGE CT
ENCINITAS CA
92024-5838
US

IV. Provider business mailing address

521 HIDDEN RIDGE CT
ENCINITAS CA
92024-5838
US

V. Phone/Fax

Practice location:
  • Phone: 914-806-7112
  • Fax:
Mailing address:
  • Phone: 914-806-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number159329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: