Provider Demographics
NPI:1871749887
Name:PUCCI, LAURA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:PUCCI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 GEARY RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4661
Mailing Address - Country:US
Mailing Address - Phone:415-793-9608
Mailing Address - Fax:925-287-9011
Practice Address - Street 1:1950 GEARY RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4661
Practice Address - Country:US
Practice Address - Phone:415-793-9608
Practice Address - Fax:925-287-9011
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-10
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical