Healthcare Provider Details

I. General information

NPI: 1093472789
Provider Name (Legal Business Name): REGINA CUCCI PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 STRAUSS ST
STATEN ISLAND NY
10305-2986
US

IV. Provider business mailing address

19 STRAUSS ST
STATEN ISLAND NY
10305-2986
US

V. Phone/Fax

Practice location:
  • Phone: 718-683-6161
  • Fax:
Mailing address:
  • Phone: 718-683-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: