Healthcare Provider Details

I. General information

NPI: 1407684103
Provider Name (Legal Business Name): REBECCA ANN CUCINA CSC-AD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300B SCHOLLS LN
FREDERICK MD
21701-6380
US

IV. Provider business mailing address

300B SCHOLLS LN
FREDERICK MD
21701-6380
US

V. Phone/Fax

Practice location:
  • Phone: 240-815-7300
  • Fax: 301-898-2918
Mailing address:
  • Phone: 240-815-7300
  • Fax: 301-898-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSC3243
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: