Provider Demographics
NPI:1568894624
Name:DUCCINI, STEPHANIE RUTH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:RUTH
Last Name:DUCCINI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:RUTH
Other - Last Name:MICHAELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMFT
Mailing Address - Street 1:1908 BUSINESS CENTER DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3468
Mailing Address - Country:US
Mailing Address - Phone:909-890-5930
Mailing Address - Fax:
Practice Address - Street 1:1908 BUSINESS CENTER DR STE 220
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3468
Practice Address - Country:US
Practice Address - Phone:909-890-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69691106H00000X
CA102787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist