Provider Demographics
NPI:1639104128
Name:KUCYK, NINA MARIE (PSYD, PCC-S, NCC)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MARIE
Last Name:KUCYK
Suffix:
Gender:F
Credentials:PSYD, PCC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1513
Mailing Address - Country:US
Mailing Address - Phone:330-956-5691
Mailing Address - Fax:330-956-5682
Practice Address - Street 1:2401 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1513
Practice Address - Country:US
Practice Address - Phone:330-956-5681
Practice Address - Fax:330-956-5682
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3276-SVPR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000476946OtherANTHEM BCBS