Provider Demographics
NPI:1306259825
Name:MUCCI, NICOLA (PSYD)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:MUCCI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 2ND AVE
Mailing Address - Street 2:STE 680
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3433
Mailing Address - Country:US
Mailing Address - Phone:206-826-3040
Mailing Address - Fax:
Practice Address - Street 1:1191 2ND AVE STE 680
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3433
Practice Address - Country:US
Practice Address - Phone:206-826-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60743633103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038177Medicaid