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NPI Code Detail

MEDICARE: MRS. EMILIE PUCKETT NICOTRA LCSW

MEDICARE: MRS. EMILIE PUCKETT NICOTRA LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker005654CT

General Provider Information

NPI Number : 1053627851
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EMILIE PUCKETT NICOTRA LCSW
Provider Business Mailing Address
First Line : 238 RIDGEWOOD AVE
Second Line :
City : HAMDEN
State : CT
Zip : 06517-1426
Country : US
Telephone Number : 203-287-9555
Fax Number :
Provider Business Practice Location Address
First Line : 2446 WHITNEY AVE
Second Line :
City : HAMDEN
State : CT
Zip : 06518-3233
Country : US
Telephone Number : 804-986-6871
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2010
Last Update Date : 09/16/2015

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