Provider Demographics
NPI:1366578783
Name:PUCCI, LINDA S (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:PUCCI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:MARINACCIO
Other - Last Name:PUCCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:202 RIVER FORD DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-3902
Mailing Address - Country:US
Mailing Address - Phone:865-983-7544
Mailing Address - Fax:865-379-8272
Practice Address - Street 1:202 RIVER FORD DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-3902
Practice Address - Country:US
Practice Address - Phone:865-983-7544
Practice Address - Fax:865-379-8272
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3089507OtherBLUE CROSS PROVIDER NUMBE
TN391457976-01OtherDEERE PROVIDER NUMBER
TN116947OtherVALUEOPTIONS
TN30224OtherCARITEN PROVIDER NUMBER
TN1045131OtherCIGNA PROVIDER NUMBER
TN391457976-01OtherDEERE PROVIDER NUMBER