Provider Demographics
NPI:1720283286
Name:RAGUCCI, ROBERT PHILIP (LMFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PHILIP
Last Name:RAGUCCI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7816 POTRERO AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2026
Mailing Address - Country:US
Mailing Address - Phone:510-234-2319
Mailing Address - Fax:510-233-7516
Practice Address - Street 1:1350 SOLANO AVE SUITE 4
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1853
Practice Address - Country:US
Practice Address - Phone:510-529-1169
Practice Address - Fax:510-233-7516
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37251106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60786OtherAC BHCS CLINICIAN #