Provider Demographics
NPI:1235353665
Name:NUCCIO, THERESA J (MSW MASTER OF SOCIAL)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:J
Last Name:NUCCIO
Suffix:
Gender:F
Credentials:MSW MASTER OF SOCIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1513
Mailing Address - Country:US
Mailing Address - Phone:206-324-5616
Mailing Address - Fax:
Practice Address - Street 1:5426 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1513
Practice Address - Country:US
Practice Address - Phone:206-324-5616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000060361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical