Healthcare Provider Details

I. General information

NPI: 1518036813
Provider Name (Legal Business Name): JAMES M MUCIA LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 FENN ST BRIEN CENTER
PITTSFIELD MA
01201-5269
US

IV. Provider business mailing address

3 ELAINE DR
PITTSFIELD MA
01201-4417
US

V. Phone/Fax

Practice location:
  • Phone: 413-496-9671
  • Fax: 413-445-6242
Mailing address:
  • Phone: 413-442-5546
  • Fax: 413-445-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: