Provider Demographics
NPI:1861376592
Name:PRUCEY, RAVIN JANINE (RBT)
Entity type:Individual
Prefix:
First Name:RAVIN
Middle Name:JANINE
Last Name:PRUCEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-6052
Mailing Address - Country:US
Mailing Address - Phone:574-395-0018
Mailing Address - Fax:
Practice Address - Street 1:418 E MISHAWAKA AVE
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-6820
Practice Address - Country:US
Practice Address - Phone:574-323-0922
Practice Address - Fax:574-323-0922
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-376905106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician