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General NPI Number Information
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NPI Number | 1639104128
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Entity Type | Individual
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Provider Name | NINA MARIE KUCYK PSY.D, PCC-S, NCC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 2401 WHIPPLE AVE NW
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City | CANTON
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State | OH
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Zip | 44708-1513
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Country | US
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Telephone | 330-956-5681
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Fax | 330-956-5682
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Provider Business Mailing Address
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Address Line | 2401 WHIPPLE AVE NW
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City | CANTON
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State | OH
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Zip | 44708-1513
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Country | US
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Telephone | 330-956-5691
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Fax | 330-956-5682
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E3276-SVPR
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License Number State | OH
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