Provider Demographics
NPI:1518125400
Name:PUCETA, KATHERINE ANN (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:PUCETA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:PUCETA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 2855
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-2855
Mailing Address - Country:US
Mailing Address - Phone:406-450-2432
Mailing Address - Fax:406-338-5369
Practice Address - Street 1:353 STARR SCHOOL RD
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417-2855
Practice Address - Country:US
Practice Address - Phone:406-450-2432
Practice Address - Fax:406-338-5369
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000052891OtherBLUE CROSS-SHIELD OF MONTANA
MT0000052891OtherBLUE CROSS-SHIELD OF MONTANA