Provider Demographics
NPI:1730327669
Name:CUCCIA MEYER, KIMBERLY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:CUCCIA MEYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 STATE ROUTE 17M W
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1020
Mailing Address - Country:US
Mailing Address - Phone:215-435-1643
Mailing Address - Fax:
Practice Address - Street 1:1661 STATE ROUTE 17M W
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1020
Practice Address - Country:US
Practice Address - Phone:215-435-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY077462-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health