Healthcare Provider Details

I. General information

NPI: 1245650118
Provider Name (Legal Business Name): ROSEMARY CUCCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEBARTOLO PL SUITE 220
YOUNGSTOWN OH
44512-7011
US

IV. Provider business mailing address

1130 SHARROTT RUN PL
NORTH LIMA OH
44452-9584
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-7828
  • Fax:
Mailing address:
  • Phone: 330-965-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP 392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: