Provider Demographics
NPI:1518923770
Name:GALLUCCIO RICHARDSON, ROBERTA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:GALLUCCIO RICHARDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E 57TH ST
Mailing Address - Street 2:2 D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3066
Mailing Address - Country:US
Mailing Address - Phone:646-342-7737
Mailing Address - Fax:212-758-2161
Practice Address - Street 1:20 E 68TH ST
Practice Address - Street 2:SUITE 212 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5844
Practice Address - Country:US
Practice Address - Phone:646-342-7737
Practice Address - Fax:212-758-2161
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM6371Medicare ID - Type Unspecified