Healthcare Provider Details

I. General information

NPI: 1720092174
Provider Name (Legal Business Name): CARMEN CUCCIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 COLBURN CT
WAYNE NJ
07470-8211
US

IV. Provider business mailing address

11 COLBURN CT
WAYNE NJ
07470-8211
US

V. Phone/Fax

Practice location:
  • Phone: 973-696-5668
  • Fax: 73-305-8078
Mailing address:
  • Phone: 973-696-5668
  • Fax: 73-305-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC47472
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: