Healthcare Provider Details

I. General information

NPI: 1134119159
Provider Name (Legal Business Name): REBECCA LYNN PUCHY L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10372-B DEMOCRACY LANE CORNERSTONE FAMILY COUNSELING
FAIRFAX VA
22030
US

IV. Provider business mailing address

10372-B DEMOCRACY LANE CORNERSTONE FAMILY COUNSELING
FAIRFAX VA
22030
US

V. Phone/Fax

Practice location:
  • Phone: 703-591-2551
  • Fax: 703-591-2563
Mailing address:
  • Phone: 703-591-2551
  • Fax: 703-591-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003629
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003023
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: