Provider Demographics
NPI:1225148786
Name:PUCCIARELLO, ANDREA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PUCCIARELLO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8058 DRY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8598
Mailing Address - Country:US
Mailing Address - Phone:303-524-0050
Mailing Address - Fax:
Practice Address - Street 1:8058 DRY CREEK CIR
Practice Address - Street 2:
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80503-8598
Practice Address - Country:US
Practice Address - Phone:303-524-0050
Practice Address - Fax:720-677-5532
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307391041C0700X
CO11281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
246101OtherCOMPSYCH
503540OtherVALUE OPTIONS
CO9000147357Medicaid
TX0026HVOtherBC BS OF TEXAS
9223591OtherPHCS