Provider Demographics
NPI:1205137171
Name:RUFFIN, NICOLE CLEOPATRA (LMSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:CLEOPATRA
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12637 148TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1904
Mailing Address - Country:US
Mailing Address - Phone:347-683-9331
Mailing Address - Fax:718-322-8860
Practice Address - Street 1:4209 28TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4131
Practice Address - Country:US
Practice Address - Phone:347-396-7191
Practice Address - Fax:347-396-8998
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker