Healthcare Provider Details

I. General information

NPI: 1225148786
Provider Name (Legal Business Name): ANDREA PUCCIARELLO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/28/2023
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8058 DRY CREEK CIR
NIWOT CO
80503-8598
US

IV. Provider business mailing address

8058 DRY CREEK CIR
NIWOT CO
80503-8598
US

V. Phone/Fax

Practice location:
  • Phone: 303-524-0050
  • Fax: 720-677-5532
Mailing address:
  • Phone: 303-524-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30739
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1128
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: