Provider Demographics
NPI:1437637519
Name:CUCINOTTA, TRACI LYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:CUCINOTTA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HIGHLAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1545
Mailing Address - Country:US
Mailing Address - Phone:978-808-1941
Mailing Address - Fax:
Practice Address - Street 1:158 HIGHLAND AVE APT 2
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1545
Practice Address - Country:US
Practice Address - Phone:978-808-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical