MEDICARE: ROBERT PHILIP RAGUCCI LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 37251	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60786	OTHER	CA	AC BHCS CLINICIAN #

General Provider Information

NPI Number	:	1720283286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT PHILIP RAGUCCI LMFT

Provider Business Mailing Address
First Line	:	7816 POTRERO AVE
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2026
Country	:	US
Telephone Number	:	510-234-2319
Fax Number	:	510-233-7516

Provider Business Practice Location Address
First Line	:	1350 SOLANO AVE SUITE 4
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1853
Country	:	US
Telephone Number	:	510-529-1169
Fax Number	:	510-233-7516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	03/22/2021

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