Healthcare Provider Details

I. General information

NPI: 1962643783
Provider Name (Legal Business Name): VINCENT RUSCELLI PHD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 BLOSSOM ST SUITE B
WEBSTER TX
77598-4236
US

IV. Provider business mailing address

560 BLOSSOM SUITE B
WEBSTER TX
77598
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-1382
  • Fax: 281-316-1362
Mailing address:
  • Phone: 281-338-1382
  • Fax: 281-316-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number21088
License Number StateTX

VIII. Authorized Official

Name: VINCENT RUSCELLI
Title or Position: PRESIDENT
Credential: PHD
Phone: 281-338-4000