1134119159 NPI number — MRS. REBECCA LYNN PUCHY L.C.S.W.

Table of content: MRS. REBECCA LYNN PUCHY L.C.S.W. (NPI 1134119159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134119159 NPI number — MRS. REBECCA LYNN PUCHY L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUCHY
Provider First Name:
REBECCA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134119159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10372-B DEMOCRACY LANE
Provider Second Line Business Mailing Address:
CORNERSTONE FAMILY COUNSELING
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-591-2551
Provider Business Mailing Address Fax Number:
703-591-2563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10372-B DEMOCRACY LANE
Provider Second Line Business Practice Location Address:
CORNERSTONE FAMILY COUNSELING
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-591-2551
Provider Business Practice Location Address Fax Number:
703-591-2563
Provider Enumeration Date:
10/21/2005

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: 1041C0700X , with the licence number:  CSW003629 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904003023 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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