Provider Demographics
NPI:1902419591
Name:FALLUCCA, BRITTNEY MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRITTNEY
Middle Name:MARIE
Last Name:FALLUCCA
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 1:46 W 14TH ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7521
Mailing Address - Country:US
Mailing Address - Phone:609-364-5974
Mailing Address - Fax:
Practice Address - Street 1:1 N BROADWAY STE 704
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2320
Practice Address - Country:US
Practice Address - Phone:609-364-5974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023669103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist