Provider Demographics
NPI:1982843827
Name:RISTUCCIA, PATRICE MARIE (MS, CAS)
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:MARIE
Last Name:RISTUCCIA
Suffix:
Gender:F
Credentials:MS, CAS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:550 LATONA RD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2700
Mailing Address - Country:US
Mailing Address - Phone:585-234-1976
Mailing Address - Fax:585-225-4223
Practice Address - Street 1:550 LATONA RD
Practice Address - Street 2:BUILDING C
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2700
Practice Address - Country:US
Practice Address - Phone:585-234-1976
Practice Address - Fax:585-225-4223
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003744-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health