Provider Demographics
NPI:1437469160
Name:PUCCIO, ROSE ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ROSE ANN
Middle Name:
Last Name:PUCCIO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 6D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-7769
Mailing Address - Country:US
Mailing Address - Phone:917-974-2710
Mailing Address - Fax:
Practice Address - Street 1:2600 HENRY HUDSON PKWY
Practice Address - Street 2:APT 6D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7769
Practice Address - Country:US
Practice Address - Phone:917-974-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011608-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist