Provider Demographics
NPI:1932250412
Name:PUGH, NANCY LUCILLE (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LUCILLE
Last Name:PUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 M ST NW
Mailing Address - Street 2:SUITE 429
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1404
Mailing Address - Country:US
Mailing Address - Phone:202-955-5687
Mailing Address - Fax:202-223-3939
Practice Address - Street 1:2440 M ST NW
Practice Address - Street 2:SUITE 429
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1404
Practice Address - Country:US
Practice Address - Phone:202-955-5687
Practice Address - Fax:202-223-3939
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1676OtherPSYCHOLOGY LICENSE