Provider Demographics
NPI:1508118886
Name:CUCURA, NICOLE E (LMSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:CUCURA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WIERK AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-2117
Mailing Address - Country:US
Mailing Address - Phone:845-295-4100
Mailing Address - Fax:
Practice Address - Street 1:6 WIERK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-2117
Practice Address - Country:US
Practice Address - Phone:845-295-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079157-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool