Provider Demographics
NPI:1124142021
Name:BRUCCULERI, MARIA BERSTEIN (EDD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:BERSTEIN
Last Name:BRUCCULERI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 DARLENE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2057
Mailing Address - Country:US
Mailing Address - Phone:508-787-9713
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1661
Practice Address - Country:US
Practice Address - Phone:508-787-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6504103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7428353OtherAETNA
MA455196OtherTUFTS HEALTH PLAN
MA6162351OtherUNITED HEALTH CARE
MAW06109OtherBCBS INDEMNITY
MA1005820OtherNEIGHBORHOOD HEALTH PLAN
MA013120OtherHARVARD PILGRIM HEALTH CA
MA52402OtherFALLON COMMUNITY HEALTH P
MA7428353OtherAETNA