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NPI Code Detail

MEDICARE: MR. PAUL R PUCCINELLI

MEDICARE: MR. PAUL R PUCCINELLI
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1689956286
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PAUL R PUCCINELLI
Provider Business Mailing Address
First Line : 15 AUSTIN AVE
Second Line :
City : SAN ANSELMO
State : CA
Zip : 94960-2924
Country : US
Telephone Number : 415-342-2839
Fax Number :
Provider Business Practice Location Address
First Line : 15 AUSTIN AVE
Second Line :
City : SAN ANSELMO
State : CA
Zip : 94960-2924
Country : US
Telephone Number : 415-342-2839
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2011
Last Update Date : 02/23/2023

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Directions to “ MR. PAUL R PUCCINELLI ” Practice Location

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