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General NPI Number Information
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NPI Number | 1871626648
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Entity Type | Individual
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Provider Name | JOANNE PECUCH LCSW, PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 6810 N STATE ROAD 7 STE 124
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4304
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Country | US
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Telephone | 305-807-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 6503 NW 66TH WAY
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City | PARKLAND
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State | FL
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Zip | 33067-1415
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Country | US
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Telephone | 305-807-1313
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Fax |
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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 | SW8568
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7759
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License Number State | FL
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