Healthcare Provider Details

I. General information

NPI: 1780288225
Provider Name (Legal Business Name): VICTORIA RUOCCO MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 11/25/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 N MAIN ST STE 318
SAYVILLE NY
11782-2512
US

IV. Provider business mailing address

43 IRMA DR
OCEANSIDE NY
11572-5715
US

V. Phone/Fax

Practice location:
  • Phone: 631-954-2657
  • Fax:
Mailing address:
  • Phone: 516-993-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: