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General NPI Number Information
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NPI Number | 1144537754
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Entity Type | Individual
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Provider Name | RUSSELL J PUCHE LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 1420 WALNUT ST SUITE 500
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4017
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Country | US
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Telephone | 215-546-2200
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Fax | 215-546-8730
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Provider Business Mailing Address
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Address Line | 1420 WALNUT ST SUITE 500
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4017
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Country | US
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Telephone | 215-546-2200
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Fax | 215-546-8730
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW016682
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License Number State | PA
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