1487265484 NPI number — KATELYNN DWYER PUCCI MA, LPC, LCAT

Table of content: KATELYNN DWYER PUCCI MA, LPC, LCAT (NPI 1487265484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487265484 NPI number — KATELYNN DWYER PUCCI MA, LPC, LCAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUCCI
Provider First Name:
KATELYNN
Provider Middle Name:
DWYER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC, LCAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DWYER
Provider Other First Name:
KATELYNN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487265484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 S MONACO ST APT 1111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80237-3454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-592-7337
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5585 ERINDALE DR STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80918-6969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-345-2424
Provider Business Practice Location Address Fax Number:
855-719-2549
Provider Enumeration Date:
08/12/2020

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:  .0022149 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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