Provider Demographics
NPI:1205995180
Name:CELLUCCI, ANTHONY J (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:CELLUCCI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:231 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8947
Mailing Address - Country:US
Mailing Address - Phone:252-702-3475
Mailing Address - Fax:
Practice Address - Street 1:EAST CAROLINA UNIVERSITY, 5TH STREET
Practice Address - Street 2:ECU PASS, RAWL BLD, 301
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-737-4180
Practice Address - Fax:252-737-4166
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1018OtherNC PSYCHOLOGY LICENSE