Provider Demographics
NPI:1902027188
Name:PARUCKA, ROBIN MARY LORALEI (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN MARY
Middle Name:LORALEI
Last Name:PARUCKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY ROBIN
Other - Middle Name:LORALEI
Other - Last Name:PARUCKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:81 FAIR OAKS LANE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65079-5593
Mailing Address - Country:US
Mailing Address - Phone:573-374-1614
Mailing Address - Fax:573-374-1614
Practice Address - Street 1:81 FAIR OAKS LANE
Practice Address - Street 2:
Practice Address - City:SUNRISE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65079-5593
Practice Address - Country:US
Practice Address - Phone:573-374-1614
Practice Address - Fax:573-374-1614
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005550103T00000X, 103TA0400X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent