Provider Demographics
NPI:1124166848
Name:RUCKMAN, ELEANOR (MFT, ATR)
Entity type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:
Last Name:RUCKMAN
Suffix:
Gender:F
Credentials:MFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SANTA CLARA AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1323
Mailing Address - Country:US
Mailing Address - Phone:510-414-9728
Mailing Address - Fax:
Practice Address - Street 1:166 SANTA CLARA AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1323
Practice Address - Country:US
Practice Address - Phone:510-414-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40803106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist