Provider Demographics
NPI:1962631382
Name:PUCCI, NICOLE (MSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:PUCCI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 MCLEOD DR
Mailing Address - Street 2:#5
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4405
Mailing Address - Country:US
Mailing Address - Phone:702-898-5311
Mailing Address - Fax:702-222-3275
Practice Address - Street 1:6402 MCLEOD DR
Practice Address - Street 2:#5
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4405
Practice Address - Country:US
Practice Address - Phone:702-898-5311
Practice Address - Fax:702-222-3275
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical