Provider Demographics
NPI:1215608054
Name:NUCERA, DONNA GABRIELLA (LAC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:GABRIELLA
Last Name:NUCERA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 OLD TAPPAN RD STE 7
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7088
Mailing Address - Country:US
Mailing Address - Phone:201-561-4176
Mailing Address - Fax:
Practice Address - Street 1:183 OLD TAPPAN RD STE 7
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-7088
Practice Address - Country:US
Practice Address - Phone:201-561-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00590800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
700J07595OtherBLUE CROSS BLUE SHIELD