Provider Demographics
NPI:1518670611
Name:PUCCIO, COURTNEY (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PUCCIO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:11 DAHLIA RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2805
Mailing Address - Country:US
Mailing Address - Phone:732-740-3192
Mailing Address - Fax:
Practice Address - Street 1:11 DAHLIA RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2805
Practice Address - Country:US
Practice Address - Phone:732-740-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-20-44235103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst