Healthcare Provider Details

I. General information

NPI: 1205575065
Provider Name (Legal Business Name): CARLA CUCINATTI LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WEDGEMERE AVE
WINCHESTER MA
01890-3511
US

IV. Provider business mailing address

7 WEDGEMERE AVE
WINCHESTER MA
01890-3511
US

V. Phone/Fax

Practice location:
  • Phone: 617-894-9645
  • Fax:
Mailing address:
  • Phone: 617-894-9645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number110313
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: