Provider Demographics
NPI:1053337899
Name:GALLUCCI, NICHOLAS THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:GALLUCCI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 LAGANA AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1213
Mailing Address - Country:US
Mailing Address - Phone:860-985-7132
Mailing Address - Fax:
Practice Address - Street 1:185 LAGANA AVE
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1213
Practice Address - Country:US
Practice Address - Phone:860-985-7132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001373103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist