Provider Demographics
NPI:1982253639
Name:RUCCI, KAYA ROSE (MHC-P)
Entity Type:Individual
Prefix:
First Name:KAYA
Middle Name:ROSE
Last Name:RUCCI
Suffix:
Gender:F
Credentials:MHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BROOK LN
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3866
Mailing Address - Country:US
Mailing Address - Phone:716-868-5292
Mailing Address - Fax:
Practice Address - Street 1:8175 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6095
Practice Address - Country:US
Practice Address - Phone:716-906-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP100219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health