Healthcare Provider Details

I. General information

NPI: 1508118886
Provider Name (Legal Business Name): NICOLE E CUCURA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WIERK AVE
LIBERTY NY
12754-2117
US

IV. Provider business mailing address

6 WIERK AVE
LIBERTY NY
12754-2117
US

V. Phone/Fax

Practice location:
  • Phone: 845-295-4100
  • Fax:
Mailing address:
  • Phone: 845-295-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number079157-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: