Provider Demographics
NPI:1417150418
Name:CUCCOVIA, NICOLA (LMHC)
Entity Type:Individual
Prefix:MR
First Name:NICOLA
Middle Name:
Last Name:CUCCOVIA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2261
Mailing Address - Country:US
Mailing Address - Phone:413-739-0882
Mailing Address - Fax:
Practice Address - Street 1:130 MAPLE ST STE 205
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2214
Practice Address - Country:US
Practice Address - Phone:413-739-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1307819Medicaid
MAY10324Medicare ID - Type Unspecified
MA1307819Medicare UPIN