Provider Demographics
NPI:1497088215
Name:FUSCO, GIANCARLO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GIANCARLO
Middle Name:
Last Name:FUSCO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MARBLE ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2736
Mailing Address - Country:US
Mailing Address - Phone:617-549-7263
Mailing Address - Fax:
Practice Address - Street 1:193 OAK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1457
Practice Address - Country:US
Practice Address - Phone:617-685-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9963103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service