Provider Information for 1750651139
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KOREY J. PUCKETT LICSW
Sex: Male
NPI: 1750651139
Last Updated: 2012-01-03
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1750651139 | ||||||||
| Enumeration Date | 2012-01-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5815 COMSTOCK AVE BALTIMORE, MD 21206-2214 United States Phone: 410-236-0028 | Fax: | ||||||||
| Primary Practice Address | 1629 K ST NW SUITE 300 WASHINGTON, DC 20006-1602 United States Phone: 410-236-0028 | Fax: | ||||||||
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