Provider Demographics
NPI:1740349299
Name:TUCKRUSKYE, DENISE BEROTTI (PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:BEROTTI
Last Name:TUCKRUSKYE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3706 REGENT LN
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1430
Mailing Address - Country:US
Mailing Address - Phone:516-735-5868
Mailing Address - Fax:516-796-7956
Practice Address - Street 1:3706 REGENT LN
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1430
Practice Address - Country:US
Practice Address - Phone:516-735-5868
Practice Address - Fax:516-796-7956
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014444-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM6611Medicare ID - Type UnspecifiedMEDICARE NUMBER