Provider Demographics
NPI:1053627851
Name:NICOTRA, EMILIE PUCKETT (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:PUCKETT
Last Name:NICOTRA
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 1:238 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1426
Mailing Address - Country:US
Mailing Address - Phone:203-287-9555
Mailing Address - Fax:
Practice Address - Street 1:2446 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3233
Practice Address - Country:US
Practice Address - Phone:804-986-6871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical