Jacqueline Pucillo

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

S87602754 Issued in MA

Practice address

30 Reynolds St
North Easton, MA 02356-1518

Phone

(508) 272-0457

NPI assigned

Jun 1, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306886400000",
    "number": "1063706513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 REYNOLDS ST",
            "city": "NORTH EASTON",
            "state": "MA",
            "postal_code": "023561518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 REYNOLDS ST",
            "city": "NORTH EASTON",
            "state": "MA",
            "postal_code": "023561518",
            "telephone_number": "508-272-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCILLO",
        "first_name": "JACQUELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-01",
        "last_updated": "2011-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "MA",
            "license": "S87602754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Charles Portman, PSY.D.
• Robert S Powell, D.O.
• Donald P Prohovich, D.D.S.
• Mia Pruett, PH.D.
• Psychological Associates of Southeastern Massachusetts, LLC
• Cailey Purcell
• Nina M. Quinn, BCBA, LABA
• Radius Easton Operating LLC
• Leena Mayuresh Rajwadkar, M.D.
• Natalia Daniela Ramirez

• Early Intervention Provider Agency in North Easton, MA
• Providers in North Easton, MA by specialty
• Early Intervention Provider Agency in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.