Provider Demographics
NPI:1467781609
Name:RUESCHENBERG, NANCY G (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:G
Last Name:RUESCHENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 PLAYA VISTA PLACE
Mailing Address - Street 2:P. O. BOX 2386
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-2386
Mailing Address - Country:US
Mailing Address - Phone:805-595-7037
Mailing Address - Fax:805-595-2703
Practice Address - Street 1:2386 PLAYA VISTA PLACE
Practice Address - Street 2:
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424-2386
Practice Address - Country:US
Practice Address - Phone:805-595-7037
Practice Address - Fax:805-595-2703
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10198103T00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist