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General NPI Number Information
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NPI Number | 1023035656
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Entity Type | Individual
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Provider Name | ROBERT P FUCETOLA PHD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 4444 FOREST PARK AVE DIV NEUROPSYCHOLOGY, 2ND FL
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2212
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Country | US
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Telephone | 314-362-1408
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Fax | 314-454-7759
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-362-1408
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Fax | 314-454-7759
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 01900
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License Number State | MO
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