Active NPI
Sarah Vida Puccia, PSY.D.
- Psychologist
- Chicago, IL
National Provider Identifier
1083952907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071.008339
- Practice address
- 3601 N Ashland Ave
Chicago, IL 60613-3660 - Phone
- (872) 222-9153
- NPI assigned
- Jan 28, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071.008339 | IL | Primary |
Addresses
Primary practice location
3601 N Ashland Ave
Chicago, IL 60613-3660
Mailing address
1324 W Thorndale Ave
Chicago, IL 60660-3306
Phone (773) 852-7119
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 20, 2021 through Jan 20, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.008339 | IL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359331200000",
"number": "1083952907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1324 W THORNDALE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606603306",
"telephone_number": "773-852-7119",
"fax_number": "773-784-4035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3601 N ASHLAND AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606133660",
"telephone_number": "872-222-9153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCCIA",
"first_name": "SARAH",
"middle_name": "VIDA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-01-28",
"last_updated": "2013-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071.008339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.