Provider Demographics
NPI:1356433593
Name:BELLUCCI, PATRICIA (PHD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BELLUCCI
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 1:125 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3710
Mailing Address - Country:US
Mailing Address - Phone:212-787-3985
Mailing Address - Fax:646-314-9053
Practice Address - Street 1:125 RIVERSIDE DR
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3710
Practice Address - Country:US
Practice Address - Phone:212-787-3985
Practice Address - Fax:646-314-9053
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013409103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV056D1Medicare ID - Type UnspecifiedMEDICARE NUMBER