Provider Demographics
NPI:1467336586
Name:RUCINSKI, NICOLE MARIE (APCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:RUCINSKI
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 48TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2133
Mailing Address - Country:US
Mailing Address - Phone:715-905-0761
Mailing Address - Fax:
Practice Address - Street 1:3107 FILLMORE ST STE 301
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-3497
Practice Address - Country:US
Practice Address - Phone:415-488-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional