Healthcare Provider Details

I. General information

NPI: 1518052679
Provider Name (Legal Business Name): DEBRA A CUCCI MA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 PACIFIC COAST HWY SUITE C
HERMOSA BEACH CA
90254-2200
US

IV. Provider business mailing address

3201 PACIFIC COAST HWY SUITE C
HERMOSA BEACH CA
90254-2200
US

V. Phone/Fax

Practice location:
  • Phone: 310-372-0100
  • Fax: 310-372-0117
Mailing address:
  • Phone: 310-372-0100
  • Fax: 310-372-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC37455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: