Michael Anthony Cucciare, PH.D.
Individual provider Active NPI Clinical Psychologist · Little Rock, AR
NPI 1124309018 · NPPES record last updated Sep 10, 2013
Key facts
- NPI
- 1124309018
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 13-05AP-PL (AR)
- Practice address
- 4301 W Markham St # 783
Little Rock, AR 72205-7101 - Phone
- (501) 686-8000
- Fax
- (501) 526-6562
- NPI assigned
- Sep 6, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13-05AP-PL | AR | MD | Clinical Psychologist |
| PSY24284 | CA | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY24284 | CA | |
| Clinical Psychologist | 103TC0700X | 13-05AP-PL | AR | Yes |
Addresses
Primary practice location
4301 W Markham St # 783
Little Rock, AR 72205-7101
Mailing address
795 Willow Road (152)
Menlo Park, CA 94025
Phone (650) 493-5000
Other providers in Little Rock, AR
- Leah K Cruthis
- Zoey M Crystal
- CSCB Rehabilitation Management Group, LLC
- Lauren McKenzie Csonka
- Julia Cucarola
- Nancy S. Culbertson
- Anna Cullum
- Desiree Cullum
- William Combs Culp
- Culpepper Chiropractic Center PA
All providers in Little Rock, AR · Clinical Psychologist in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.