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General NPI Number Information
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NPI Number | 1205137171
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Entity Type | Individual
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Provider Name | NICOLE CLEOPATRA RUFFIN LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 4209 28TH ST
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-4131
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Country | US
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Telephone | 347-396-7191
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Fax | 347-396-8998
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Provider Business Mailing Address
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Address Line | 12637 148TH ST
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11436-1904
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Country | US
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Telephone | 347-683-9331
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Fax | 718-322-8860
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 076836
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License Number State | NY
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