Mark Dominic Bertucci, PSYD, LP
NPI 1376055665ActiveIndividual· Psychologist, Clinical· Burnsville, MN
Psychologist, Clinical (PSYD, LP) with Park Nicollet Clinic, practicing in Burnsville, Minnesota. Enrolled in Medicare as practitioner - clinical psychologist.
Overview
| NPI | 1376055665 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PSYD, LP |
| Sole proprietor | No |
| NPI issued | Oct 26, 2017 |
| Last updated in NPPES | Mar 17, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychologist, Clinical Primary | 103TC0700X | LP6174 | MN |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Clinical Psychologist (MN) |
|---|
Education and affiliations
| Graduation year | 2016 |
|---|---|
| Medicare specialty | Clinical Psychologist |
Medical group
- Park Nicollet ClinicSt Louis Park, MN · 1,787 clinicians
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All 31 clinical psychologists in Burnsville · All clinical psychologists in Minnesota