Healthcare Provider Details

I. General information

NPI: 1790676757
Provider Name (Legal Business Name): KATHERINE ANNE CUCINOTTA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 BRIARCLIFF RD NE
ATLANTA GA
30329-4010
US

IV. Provider business mailing address

1920 BRIARCLIFF RD NE
ATLANTA GA
30329-4010
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-9350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79424
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: