Healthcare Provider Details

I. General information

NPI: 1295807147
Provider Name (Legal Business Name): ROBERT J NARUCKI M.A., CP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 MAIN ST SUITE ONE
COLCHESTER VT
05446-4420
US

IV. Provider business mailing address

899 MAIN ST SUITE ONE
COLCHESTER VT
05446-4420
US

V. Phone/Fax

Practice location:
  • Phone: 802-872-7645
  • Fax: 802-872-2795
Mailing address:
  • Phone: 802-872-7645
  • Fax: 802-872-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number047-0000738
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number047-0000738
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: