Provider Demographics
NPI:1295807147
Name:NARUCKI, ROBERT J (MA, CP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:NARUCKI
Suffix:
Gender:M
Credentials:MA, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 MAIN ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4420
Mailing Address - Country:US
Mailing Address - Phone:802-872-7645
Mailing Address - Fax:802-872-2795
Practice Address - Street 1:899 MAIN ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4420
Practice Address - Country:US
Practice Address - Phone:802-872-7645
Practice Address - Fax:802-872-2795
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000738103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1295807147OtherBLUE CROSS BLUE SHIELD
644443OtherVALUEOPTIONS
VT9543568OtherAETNA
VT2115240OtherFIRST HEALTH
200229625OtherCAPITAL DISTRICT PHYSICIANS' HEALTH PLAN
2115240OtherCOVENTRY
3009290OtherMVP
VT000466088OtherUNITED BEHAVIORAL HEALTH
VT1018501Medicaid
VT2599445OtherCIGNA
644443OtherVALUEOPTIONS MILITARY ONESOURCE
VT1295807147OtherBCBS
200229625OtherCDPHP
9543568OtherAETNA
VT3009290OtherMVP