Provider Demographics
NPI:1548381247
Name:COLUCCI, STEVEN - (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:-
Last Name:COLUCCI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5909
Mailing Address - Country:US
Mailing Address - Phone:401-294-7274
Mailing Address - Fax:401-667-0980
Practice Address - Street 1:215 PINECREST DR
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5909
Practice Address - Country:US
Practice Address - Phone:401-294-7274
Practice Address - Fax:401-667-0980
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00429103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent