Provider Demographics
NPI:1861262727
Name:RUFFATTO, NICHOLE REGEL (LCSW)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:REGEL
Last Name:RUFFATTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BUCKHORN TRL
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7944
Mailing Address - Country:US
Mailing Address - Phone:406-314-1980
Mailing Address - Fax:
Practice Address - Street 1:4455 ANNIE ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5705
Practice Address - Country:US
Practice Address - Phone:406-314-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-698271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical