Healthcare Provider Details

I. General information

NPI: 1053569756
Provider Name (Legal Business Name): CYNTHIA ANN PUCHAMMER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 CARSAM ST
FANWOOD NJ
07023-1609
US

IV. Provider business mailing address

31 CARSAM ST
FANWOOD NJ
07023-1609
US

V. Phone/Fax

Practice location:
  • Phone: 908-889-0714
  • Fax: 732-549-2695
Mailing address:
  • Phone: 908-889-0714
  • Fax: 732-549-2695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number44SC05307500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05307500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number44SC05307500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: