Provider Demographics
NPI:1134119159
Name:PUCHY, REBECCA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:PUCHY
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 1:10372-B DEMOCRACY LANE
Mailing Address - Street 2:CORNERSTONE FAMILY COUNSELING
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-591-2551
Mailing Address - Fax:703-591-2563
Practice Address - Street 1:10372-B DEMOCRACY LANE
Practice Address - Street 2:CORNERSTONE FAMILY COUNSELING
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-591-2551
Practice Address - Fax:703-591-2563
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036291041C0700X
VA09040030231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical