Provider Demographics
NPI:1740303940
Name:NUCCITELLI, MICHAEL JOHN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:NUCCITELLI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57 INNSBRUCK BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-8315
Mailing Address - Country:US
Mailing Address - Phone:845-629-0205
Mailing Address - Fax:845-279-6221
Practice Address - Street 1:2505 CARMEL AVE STE 210
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-1122
Practice Address - Country:US
Practice Address - Phone:845-629-0205
Practice Address - Fax:845-279-6221
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical