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General NPI Number Information
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NPI Number | 1962643783
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Entity Type | Organization
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Legal Business Name | VINCENT RUSCELLI PHD,PC
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 560 BLOSSOM ST SUITE B
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City | WEBSTER
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State | TX
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Zip | 77598-4236
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Country | US
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Telephone | 281-338-1382
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Fax | 281-316-1362
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Provider Business Mailing Address
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Address Line | 560 BLOSSOM SUITE B
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 281-338-1382
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Fax | 281-316-1362
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Authorized Official
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Title or Position | PRESIDENT
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Name | VINCENT RUSCELLI
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Credential | PHD
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Telephone | 281-338-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 21088
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License Number State | TX
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