Provider Demographics
NPI:1922890185
Name:PUCCI, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:PUCCI
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 1:2 CLYDESDALE LN
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1144
Mailing Address - Country:US
Mailing Address - Phone:508-244-1295
Mailing Address - Fax:
Practice Address - Street 1:333 ELM ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4530
Practice Address - Country:US
Practice Address - Phone:508-244-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical