Provider Demographics
NPI:1245650118
Name:CUCCIA, ROSEMARY
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:CUCCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SHARROTT RUN PL
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-9584
Mailing Address - Country:US
Mailing Address - Phone:330-965-7828
Mailing Address - Fax:
Practice Address - Street 1:100 DEBARTOLO PL
Practice Address - Street 2:SUITE 220
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-7011
Practice Address - Country:US
Practice Address - Phone:330-965-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 392103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool