Physician Compare National (NPI:1184760324)

HEALTHCARE PROVIDER: ELLA PUCCIO DSW LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1184760324
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537486097
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150320000414
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PUCCIO
	Individual professional last name
Provider First Name	ELLA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	11020 71ST RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 103
	Group Practice or individual's line 2 address
City	FOREST HILLS
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	113754905
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7188495874
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y