Provider Demographics
NPI:1043954530
Name:MARCY S PUKLIN LCSW LLC
Entity type:Organization
Organization Name:MARCY S PUKLIN LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PUKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-858-5560
Mailing Address - Street 1:21 PEQUOT DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-1608
Mailing Address - Country:US
Mailing Address - Phone:203-858-5560
Mailing Address - Fax:
Practice Address - Street 1:21 PEQUOT DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-1608
Practice Address - Country:US
Practice Address - Phone:203-858-5560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty