Provider Demographics
NPI:1265802094
Name:GEORGE RUCCIO
Entity type:Organization
Organization Name:GEORGE RUCCIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:615-390-6127
Mailing Address - Street 1:3906 TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3104
Mailing Address - Country:US
Mailing Address - Phone:615-390-6127
Mailing Address - Fax:
Practice Address - Street 1:500 HICKORY HOLLOW TER
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2115
Practice Address - Country:US
Practice Address - Phone:615-390-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN60531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty