Provider Demographics
NPI:1144305079
Name:STRUCKUS, JOSEPH E (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:STRUCKUS
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 1:10 MAIN STREET
Mailing Address - Street 2:P.O. BOX 2219
Mailing Address - City:NEW PRESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06777-2219
Mailing Address - Country:US
Mailing Address - Phone:860-868-9000
Mailing Address - Fax:860-868-0055
Practice Address - Street 1:10 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW PRESTON
Practice Address - State:CT
Practice Address - Zip Code:06777-2219
Practice Address - Country:US
Practice Address - Phone:860-868-9000
Practice Address - Fax:860-868-0055
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001640103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist