Healthcare Provider Details

I. General information

NPI: 1679227565
Provider Name (Legal Business Name): LAUREN MARIE PUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NORTHERN BLVD
GREAT NECK NY
11021-5317
US

IV. Provider business mailing address

212 BEEBE RD
MINEOLA NY
11501-2230
US

V. Phone/Fax

Practice location:
  • Phone: 516-518-2328
  • Fax:
Mailing address:
  • Phone: 516-286-3625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number027069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: