DR. MARK DOMINIC BERTUCCI (NPI# 1376055665) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376055665 |
| Entity Type | Individual |
| Full Name | DR. MARK DOMINIC BERTUCCI |
| Credential | PSYD, LP |
| Practice Address |
675 E Nicollet Blvd Ste 250 Burnsville MN 55337-6768 |
| Mailing Address |
6929 Washburn Ave S Richfield MN 55423-1929 |
| Practice Telephone | 9529933307 |
| Mailing Telephone | 9063624078 |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
LP6174 | MN | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6 E Diamond Lake Rd, Minneapolis, MN 554191923 | 6125686077 | |
| 1910 Hennepin Ave, Minneapolis, MN 554033160 | 6128712544 |
| Street Address |
675 E NICOLLET BLVD STE 250 |
| City | BURNSVILLE |
| State | MN |
| Zip Code | 55337-6768 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043295223 | Brian R Koller | Psychiatry & Neurology | 675 E Nicollet Blvd Ste 250, Burnsville, MN 55337-6768 | 2005-12-12 |
| 1447895065 | Brandyce R Edson | Counselor | 675 E Nicollet Blvd Ste 250, Burnsville, MN 55337-6768 | 2019-11-07 |
| 1679071823 | Casey Daniel Lloyd | Psychologist | 675 E Nicollet Blvd Ste 250, Burnsville, MN 55337-6768 | 2018-01-23 |
| 1700308954 | Rebecca L Langseth | Counselor | 675 E Nicollet Blvd Ste 250, Burnsville, MN 55337-6768 | 2017-07-10 |
| 1093262115 | Lauren K Rance | Psychologist | 675 E Nicollet Blvd Ste 250, Burnsville, MN 55337-6768 | 2016-09-07 |
| 1033666342 | Tarah Pringle | Psychologist | 675 E Nicollet Blvd Ste 250, Burnsville, MN 55337 | 2016-09-02 |
| 1356634224 | Anna Venn Carlson Ellason | Registered Nurse | 675 E Nicollet Blvd Ste 250, Burnsville, MN 55337 | 2011-05-25 |
| 1497852313 | Jane Marie Sulzle | Clinical Nurse Specialist | 675 E Nicollet Blvd Ste 250, Burnsville, MN 55337 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053939397 | Alpha Quality Care1 L. L. C. | Home Infusion | 12924 18th Ave South, Burnsville, MN 55337 | 2020-07-13 |
| 1568085900 | Kathryn Harris | Counselor | 11939 W. River Hills Dr., Burnsville, MN 55337 | 2020-05-20 |
| 1952941254 | Noah Home Care Inc. | Home Health | 13521 Nicollet Lane, Burnsville, MN 55337 | 2020-01-14 |
| 1750854287 | Baraka Home Care LLC | Nursing Care | 1700 James Place, Burnsville, MN 55337 | 2019-01-08 |
| 1699298778 | Raphael Cheron-dittmann | Hearing Instrument Specialist | 14000 Nicollet Ave. S., Suite 303, Burnsville, MN 55337 | 2017-07-20 |
| 1669909818 | Mercy Home Care Ltd | Hospice Care, Community Based | 1020 E 146th St Ste 220d, Burnsville, MN 55337 | 2017-05-18 |
| 1457893984 | Daniel Ryan Nguyen | Physician Assistant | 14551 Co Rd #11 #100, Burnsville, MN 55337 | 2016-11-15 |
| 1730542572 | Iris Reproductive Psychiatric Clinic | Clinical Nurse Specialist | 1500 Mcandrews Road W, Ste 227, Burnsville, MN 55337 | 2016-03-30 |
| 1740657204 | Mercy Link, LLC | Home Health | 13005 Salem Pl, Burnsville, MN 55337 | 2015-08-31 |
| 1669852158 | Mixa Dipak Patel | Physical Therapy Assistant | 8380 Hiawatha Ave, Eden Prairie, MN 55337 | 2015-06-01 |
| Find all providers in zip 55337 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841899291 | Charlotte Mae Gerth Haanen | Psychologist | 2805 Cliff Rd E, Burnsville, MN 55337-4095 | 2020-10-17 |
| 1831722594 | Collaboration for Psychological Wellness, LLC | Psychologist | 12000 Portland Ave Ste 120, Burnsville, MN 55337-4469 | 2020-02-20 |
| 1750868212 | Nicole Marie Johnson | Psychologist | 200 E Travelers Trl Ste 205, Burnsville, MN 55337-4191 | 2018-07-26 |
| 1497991806 | Tina Dinesh Shah | Psychologist | 12400 Portland Ave Ste 120, Burnsville, MN 55337-6817 | 2009-01-07 |
| 1871619718 | Maggie Clare Happe | Psychologist | 2009 Southcross Dr W, Unit 905, Burnsville, MN 55306-7922 | 2007-03-22 |
| 1942325626 | William Hoekstra Pa | Psychologist | 1020 E 146th St, #117, Burnsville, MN 55337-6703 | 2007-03-20 |
| 1649381419 | Leslie Levine Adler | Psychologist | 200 E Travelers Trl, Suite 225, Burnsville, MN 55337-4097 | 2006-08-31 |
| 1114942950 | Dorothy Eleanor Wintz | Psychologist | 1500 Mcandrews Rd W Ste 201, Burnsville, MN 55337-4445 | 2006-07-13 |
| 1679551527 | Andrea Renee Zuellig | Psychologist | 14569 Grand Ave, Burnsville, MN 55306-5729 | 2006-01-01 |
| 1679071823 | Casey Daniel Lloyd | Psychologist | 675 E Nicollet Blvd Ste 250, Burnsville, MN 55337-6768 | 2018-01-23 |
| Find all providers in BURNSVILLE | ||||
| City | BURNSVILLE |
| Zip Code | 55337 |
Please comment or provide details below to improve the information on DR. MARK DOMINIC BERTUCCI.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.