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General NPI Number Information
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NPI Number | 1992116883
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Entity Type | Individual
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Provider Name | NICOLE PUCCI PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3659 GREEN RD STE 322
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City | BEACHWOOD
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State | OH
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Zip | 44122-5715
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Country | US
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Telephone | 216-202-5631
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Fax |
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Provider Business Mailing Address
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Address Line | 1938 E HAYMARKET WAY
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City | HUDSON
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State | OH
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Zip | 44236-4644
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Country | US
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Telephone | 330-242-1613
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7425
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License Number State | OH
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