Provider Demographics
NPI:1962643783
Name:VINCENT RUSCELLI PHD,PC
Entity Type:Organization
Organization Name:VINCENT RUSCELLI PHD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-338-4000
Mailing Address - Street 1:560 BLOSSOM
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-338-1382
Mailing Address - Fax:281-316-1362
Practice Address - Street 1:560 BLOSSOM ST
Practice Address - Street 2:SUITE B
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4236
Practice Address - Country:US
Practice Address - Phone:281-338-1382
Practice Address - Fax:281-316-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21088103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000AR418Medicaid
TX00AR41Medicare PIN