Provider Demographics
NPI:1326638719
Name:BRUCATO, GARY JR (PHD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:JR
Last Name:BRUCATO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:BRUCATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:7143 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2662
Mailing Address - Country:US
Mailing Address - Phone:347-351-7010
Mailing Address - Fax:
Practice Address - Street 1:276 5TH AVE RM 605
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4527
Practice Address - Country:US
Practice Address - Phone:917-847-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019614103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical