Healthcare Provider Details

I. General information

NPI: 1821726993
Provider Name (Legal Business Name): PRISCILLA KUCER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 CRIMSON CT
ORLANDO FL
32808-2202
US

IV. Provider business mailing address

1901 ONION CREEK PKWY APT 12105
AUSTIN TX
78748-1978
US

V. Phone/Fax

Practice location:
  • Phone: 954-773-4105
  • Fax:
Mailing address:
  • Phone: 954-773-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1249
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: