Healthcare Provider Details

I. General information

NPI: 1972031797
Provider Name (Legal Business Name): CYNTHIA PUCCIO MA, LCSW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MELNICK DR
MONSEY NY
10952-3370
US

IV. Provider business mailing address

22 SADDLE RIDGE RD
POUND RIDGE NY
10576-1110
US

V. Phone/Fax

Practice location:
  • Phone: 845-364-6861
  • Fax:
Mailing address:
  • Phone: 310-428-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074337
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: