Provider Demographics
NPI:1962529461
Name:PEYRUCAIN, NADINE GRACE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:GRACE
Last Name:PEYRUCAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MORELLO AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-3042
Mailing Address - Country:US
Mailing Address - Phone:925-228-4514
Mailing Address - Fax:
Practice Address - Street 1:100 GLACIER DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4824
Practice Address - Country:US
Practice Address - Phone:925-646-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health