1073892931 NPI number — MS. JACQUELINE GILL PUCCI LPC

Table of content: MS. JACQUELINE GILL PUCCI LPC (NPI 1073892931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073892931 NPI number — MS. JACQUELINE GILL PUCCI LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUCCI
Provider First Name:
JACQUELINE
Provider Middle Name:
GILL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILL
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073892931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 PLYMOUTH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ROCK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07452-1235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-525-9356
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49 PLYMOUTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN ROCK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07452-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-525-9356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  37PC00411900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)