Provider Demographics
NPI:1982008363
Name:RUCCIO, GEORGE WILLIAM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:RUCCIO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2801
Mailing Address - Country:US
Mailing Address - Phone:615-390-6127
Mailing Address - Fax:615-327-9399
Practice Address - Street 1:1233 17TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2801
Practice Address - Country:US
Practice Address - Phone:615-390-6127
Practice Address - Fax:615-327-9399
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN60531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical