Provider Demographics
NPI:1619537149
Name:PUCCI, CONCETTA (PHD, LICSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:CONCETTA
Middle Name:
Last Name:PUCCI
Suffix:
Gender:F
Credentials:PHD, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 KING GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4443
Mailing Address - Country:US
Mailing Address - Phone:571-356-9626
Mailing Address - Fax:
Practice Address - Street 1:11320 KING GEORGE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4443
Practice Address - Country:US
Practice Address - Phone:571-356-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040171021041C0700X
MD271921041C0700X
DC2000031361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical