Provider Demographics
NPI:1932449832
Name:PUKAY-MARTIN, NICOLE DANIELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:DANIELLE
Last Name:PUKAY-MARTIN
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 1:1000 S FORT THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2305
Mailing Address - Country:US
Mailing Address - Phone:859-572-6280
Mailing Address - Fax:
Practice Address - Street 1:1000 S FORT THOMAS AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2305
Practice Address - Country:US
Practice Address - Phone:859-572-6280
Practice Address - Fax:859-572-6223
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPP4162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical